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Dáil Éireann díospóireacht -
Wednesday, 17 Nov 2010

Vol. 722 No. 2

Nursing Home Care: Motion (Resumed)

The following motion was moved by Deputy James Reilly on Tuesday, 16 November 2010:
That Dáil Éireann:
welcomes the publication of the investigation by the Office of the Ombudsman entitled, "Who Cares? — An Investigation into the Right to Nursing Home Care in Ireland", and notes with serious concern:
that the Ombudsman encountered unprecedented opposition and a lack of co-operation from the Department of Health and Children and the HSE in the course of conducting this investigation;
that thousands of old people may have been deprived of their legal entitlement to nursing home care, under the Health Act 1970, for over four decades;
that the Government has consistently failed to clarify entitlements to nursing home care, causing huge frustration and anxiety among older people and their families;
that vulnerable older people have been forced to seek care in private homes, at huge cost to themselves and their families;
that the State currently faces more than 300 legal actions from people seeking compensation for costs incurred from private nursing home care;
that the cap on the fair deal scheme may force older people to pay for private nursing home care yet again;
that in 2004 the State was forced to repay nursing home charges it illegally imposed on thousands of older people who held medical cards; and
the persistent refusal of the Government to acknowledge the findings of reports published by the Office of the Ombudsman, and the serious implications this has for the future effectiveness of the Office of the Ombudsman; and
condemns the Department of Health and Children for its failure to cooperate adequately with the Ombudsman's investigation and calls on the Government to clarify the legal position regarding nursing home care.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"—notes the introduction by the Government of the Nursing Homes Support Scheme which legally defined eligibility for long term nursing home care and which addressed the previous inequity by equalising State support for those in public, private and voluntary nursing homes;
notes that the HSE has received almost 16,500 applications for the Fair Deal Scheme to date, of which over 12,250 have been approved with other applications continuing to be processed on a daily basis;
notes that the budget in respect of long term care for 2010 for the Fair Deal Scheme and for those remaining in public long stay facilities and receiving subvention in private facilities is over €979 million in 2010;
recognises that eligibility for in-patient services under section 52 of the Health Act 1970 has always been subject to,inter alia, the availability of resources;
notes that the jurisdiction of the Ombudsman relates primarily to administrative actions and does not encompass issues such as Government policy, legislation passed by the Oireachtas, the conduct of litigation by the State and the wider governmental process;
notes that the representations submitted to the Ombudsman set out very clearly the Minister's views on extracts from the draft report and were endorsed by the Government;
notes with concern the way this particular investigation was undertaken and, in particular, the failure to follow fair procedures;
notes this Government's commitment to services for older people which, as well as the introduction of a national scheme of financial support for long term residential care (Fair Deal) and the introduction of new standards, regulations and inspections for designated centres for older people, has also seen an additional €200 million invested in community services such as home help, home care packages, meals on wheels and day/respite care; and
supports the Minister's plans to continue to develop and improve services for older people."
—(Minister for Health and Children, Deputy Mary Harney).

I commend Fine Gael on bringing this important motion before the House in Private Members' time. More particularly, I salute the Ombudsman, Ms Emily O'Reilly, for having published an excellent and comprehensive report which investigated the operation and provision of long-term care for the elderly by the health boards, the Department of Health and Children, and the HSE. The Ombudsman has described the system as a largely chaotic and ad hoc one where confusion was sown about rights and entitlements. People were subjected to huge bills which necessitated the extraction of financial security from the elderly because of the deliberate failure of the system to clarify these people’s right to public care, let alone provide it for them.

The introduction of the fair deal or nursing home support scheme in 2009 has helped things somewhat. In her Magill School lecture, Ms O'Reilly correctly pointed out that by using this mechanism the State now believes it has divested itself of the responsibility to provide nursing home care. The principle now being proposed is that responsibility for long-term care rests with the applicant and his or her family, which is qualified as usual or dependent upon the availability of resources. It is not a demand-led scheme so there are no guarantees and if no resources are available, the applicant is placed on a waiting list. No great improvement is derived from that, however. In effect, we are witnessing the advent of mass privatisation of nursing home care provision, with a 150% increase in the number of private nursing home places over the last 12 years. This represents a rush to privatisation, which is what the Government's policy is all about. It is about subjugating public health care provision at the expense of tax breaks for the provision of private nursing home care. I have seen it at work in my own area where for many years excellent health care was provided at St. Mary's Hospital.

In her thorough investigation into the right to nursing home care in Ireland, I am glad the Ombudsman has brought to the fore an argument which dates back 40 years since the 1970 Act was passed. She referred to rights arising under the clear and precise words of the relevant sections of the Act. The Government allowed this situation to continue over the past 15 years despite numerous reports, including the Travers report. The latter report succinctly stated it was remarkable that, in the context of health service provision in Ireland, huge sums of money were expended on a system that was somewhat confused from a statutory perspective and where the practice was in fact somewhat dislocated from the statutory theory.

It is from that perspective that I would like to review some of the issues involved, particularly the legal ones. What the law provides for is characterised as a state of flux surrounding the provision and more importantly the obligation to provide long-term State care facilities for our elderly population. For up to four decades, the State through the vehicle of the old health board structure and latterly the HSE, has dodged, weaved and refused to comply with the letter of the law, which was plain and unambiguous in this regard. However one tends to construe or interpret this — either by way of literal, schematic or teleological methods — one can only conclude that the State purposely disregarded the law that applied in this area. That law imposed an obligation to provide nursing home care for our elderly citizens.

The starting point for the construction of a statutory basis is the Health Act 1970. The problem is that the State vehemently disputed the impact of that Act by availing of the oft-employed economic considerations or the availability of resources provision. The latter served to confuse or complicate the issue of eligibility. Over the years, the State and, more importantly, the Department of Health and Children, were allowed to park key requirements of the Act concerning the provision of in-patient services and thereby side step their clear statutory obligation to provide specific services.

Section 51 of the Health Act 1970 unambiguously defines in-patient services as institutional services provided to persons while maintained in a hospital, convalescent home or home for persons suffering from physical or mental disability or an accommodation ancillary thereto. This clearly incorporated the care provided in a nursing home and the Supreme Court clarified this in the McInerney ward of court case in 1976. In my view, this confirmed in an unequivocal fashion an elderly person's legal right as a geriatric patient to receive in-patient services free of charge. This clear statement of the law continued to be disregarded for the next three decades, notwithstanding the fact that it was handed down by the highest court in the land. The various health boards continued to charge medical card holders, notwithstanding the fact that it was clearly illegal to do so. This practice was abruptly ended by the introduction of the statutory health repayments scheme, which set up a mechanism for repaying those who were charged illegally for their care.

Section 52 of the Health Act 1970 reinforced this view and obligated health boards to make in-patient services available for persons with full eligibility and persons with limited eligibility. It is notable that there were no ifs, buts or maybes; the obligation was unequivocal in its mandatory imposition. It was reinforced by the fact that during the same period people had an entitlement and eligibility for in-patient services in public hospitals.

The Department articulated the view — unsustainably, in my opinion, given the mandatory nature of the legislation — that the statutory provision distinguished between eligibility and entitlement. One is compelled to the viewpoint that this was a rear-guard action to stave off the inevitability of the fact that the health boards were statutorily obliged to provide in-patient services. One would support the Ombudsman's description of the stance adopted by the Department as being of a tortuous construction, which was neither necessary nor plausible.

Part 6 of the Health Act 1970, which deals with the provision of health services, sets out a range of services to be provided, and to whom and on what terms they could be provided.

Section 60 of the Health Act 1970 provides that, as regards nursing home provision, a health board shall in relation to a person with full eligibility and such other category of persons and for such purposes as may be specified by the Minister, provide a nursing service. Eligibility is the term used solely as an identifier of those to whom the service shall or may be made available. There is no room for confusion as to the meaning of "eligibility", or that it is equivalent in meaning to "entitlement". Eligibility is used to identify the categories to whom a service shall or may be provided. It is not utilised for the purposes of defining the extent to which services must be provided. Indeed, the Ombudsman advised the Legislature that any perception, contention or confusion arising from the interchangeability of these terms — "eligibility" and "entitlement" — could have been avoided by the adoption of neutral terminology in delineating the various categories of health entitlements. She indicated that one could do so by naming them as categories 1, 2, 3, etc.

In the Tierney v North Eastern Health Board case, which dealt with another section of the Health Act, Judge Denham observed that statutes should be construed according to the intent expressed in the legislation. The words of a statute declare best the intent of an Act and consequently those words should be given their ordinary meaning and the court is bound to give effect to the clear meaning of the statute. Thus any construction of section 52 of the Health Act 1970, among others, clearly confers a statutory obligation on the health board, the HSE, etc., and confers enforceable rights on relevant individuals.

The Government had a choice concerning the provision of services as set out in the 1970 Act. By a deliberate political act, it opted to favour the provision of care for the elderly by way of private operations rather than public ones. The Boston versus Berlin debate was at its zenith in the pursuit of the privatisation of health care provision. The private argument went out clearly and obviously.

The argument for the universal provision of health care is always made in two main areas: births and young people, and care for the elderly. Variations may be made regarding the capacity argument between these two specific and clear areas. The elderly are not in a position to increase their income in any meaningful way. They are generally confined to fixed incomes. We may wonder where the funding can come from, but in a country where 80% of tax relief for private pensions goes to 20% of recipients, even reducing these to a standardised tax rate would save the State in excess of €1 billion per year. This is where it should be applied.

In the context of public health care provision for the elderly, we have a State validation system for qualifications and competencies, whereby the provision of important services for elderly citizens is based not solely on the cost of the service but on the adequacy of same. Every single social survey suggests that people want to live in contentment where possible in their own home environment for as long as possible. That possibility needs to be supported by the provision of services. Residential care should be seen as a last resort. Where services are not provided, however, people are compelled to avail of institutional care, which under the policy of this Government is essentially in private nursing homes.

I recall the efforts I made as Chairperson of the Joint Committee on Social and Family Affairs in this regard. I authored a report on carers, which brought significant improvements for them, including the payment of the half-carer's rate to people in receipt of other specific social welfare payments. I have always unashamedly and fearlessly advocated the rights of carers because I recognise their contribution to ensuring that those they care for can remain within their own home environment where they will be most contented. In doing so, they save the State billions of euro. This is why it is important not to roll back these advances. We should recognise the role of carers as real employment. The caring economy is an important sector and full PRSI recognition in terms of their contribution should be considered.

I was always, and still am, a great supporter of St. Mary's Hospital, which is the local public health hospital in Mullingar. It provided accommodation for the elderly and disabled people, particularly in mid and north Westmeath. In the early 1980s, when we had significantly fewer people in terms of age profile and dependency, up to 200 beds were available through public provision. Some 200 beds were available in straightened financial times with a smaller population base. It has now been reduced to fewer than 100, which is where this matter has gone wrong in providing private health care.

I propose to share time with Deputies Dooley, Johnny Brady, Power, O'Brien and O'Rourke.

The majority of our older people want to stay in their homes for as long as possible with their independence, dignity and family and community support. We wish that for ourselves and for the older members of our families but in some cases that is not possible and it is then incumbent on us to ensure there is equality and fairness in getting access to quality nursing home care. The nursing home support scheme, the fair deal, means a uniform system of financial support for individuals in public and private nursing home beds. It ensures individuals and their families do not face financial hardship. There has been widespread acceptance of that by most Members in this House and by people outside the House. They see equity and fairness in the scheme. Many people have made such comments to me and recognise what is available in the service.

It is important that the standards of such care are of the highest quality. Nothing else can be acceptable. If we have learned anything from the harrowing documentaries we saw on our television screens, it is that it is often traumatic for elderly people to move from home to residential care. It is a difficult decision for families to make and when people move into residential care, the care must be of the highest standard. They deserve nothing less. The Department of Health and Children accounts for one of the three highest spending Departments, along with the Department of Education and Science and the Department of Social Protection. Like any Department, it has finite resources. There is not an unlimited amount of money in the Department and in that respect it must live within its budget.

In providing residential care to the elderly, we have a mix of private and public facilities. In my constituency, we are fortunate to have an excellent quality of care. That is much more important than the physical buildings. In St. Mary's Hospital, Castleblayney, we have a residential public facility that has achieved ISO standard. It is a centre of excellence where the patient is at the heart of everything that goes on in the facility. My life in the town where I am based would be much easier if we had two or three more of these facilities, such is the demand for places. Recently I visited a facility outside Carrickmacross with the Minister for Health and Children where the McCoy family have developed the concept of a home away from home. The first thing that struck me when I entered the facility was that each unit has its own front door, doorbell and letterbox. One walks into a very inviting sitting room and kitchen and there is no need to go to the bedrooms. I was struck by the fact that people felt at home in their new place of residence. The McCoy family has made major investment in this facility and they make every effort to ensure the needs of their patients are met.

We are quick to give a negative rather than a positive view. We must recognise the good work carried out by many people working in the HSE. No organisation of that size could be without difficulties in dealing with so many people. We must live according to our means. I would like nothing more than to have an unlimited amount of money in the Department of Health and Children but the reality is something different. It is very easy to be on the sideline, shouting and knowing everything, but when one is asked to don the jersey and come onto the pitch and play one's part, it is a different reality. I commend the Minister and the Department on the increases in funding over the years and on the delivery of the fair deal. I am happy to support the amendment.

I welcome the opportunity to contribute to this debate. We are here to discuss the findings of the report of the Ombudsman. The Minister for Health and Children and the Department have come in for a considerable amount of unfair criticism. It is appropriate that the Minister should have sought to defend and protect the interests of the State as she saw fit. There is an issue of jurisdiction, which was challenged by the Minister on the basis of legal advice. It was appropriate to defend the interests of the State. Going through the detailed correspondence between the Ombudsman and the office of the Minister, it is clear there was great co-operation between the two. However, the analysis of the report seems to suggest otherwise. It is unfortunate that the Minister has been drawn into this debate when clearly her role is to defend the interests of the State against future litigation that may arise.

One need only look back to how we got to where we are. There is little doubt there was continuous failure by successive Governments to address the lacuna that existed in the law in respect of charging patients with medical cards for residential units run by the State. I was one of the few who spoke out against the rush by some to seek recompense for a damn good service provided to their loved ones at a time when they were unwilling or unavailable to do so. Sadly, many people queued up to take the bounty and run. It was appropriate to face up to the situation and deal with it constructively. Congratulations are due to the Minister for Health and Children.

My experience of the system now in place, commonly referred to as the fair deal scheme, is that it is universally accepted. It is a good scheme that assists many people in a uniform way. The previous subvention scheme provided different rates in different parts of the country. Someone living in Dublin did better or worse than someone living in Clare and that is not the way a system of administration should be allowed to continue. I do not direct these comments at the Ombudsman. In that era, when a system of inequity existed, there was justification for a negative finding from the Ombudsman. We did not have one to the best of my knowledge. Therefore, it is unfortunate that the Minister comes in for criticism when people across successive parties failed to address the issue for their own reasons. Now the Minister is pushed out by the Ombudsman when she was the first to grapple with a complex problem and resolve it conclusively. It is to the benefit of many families who had to deal with the situation as it existed. A good level of service is provided and the current system encourages the public and private sector.

The constituency with which I am most familiar has a fantastic necklace of service providers in the public and private sectors. I am very familiar with one close to where I live, Raheen Community Hospital, which provides an excellent residential service for people with longstay requirements. In conjunction with that, daycare service is provided through daycare centres in areas such as Kilmaley, Clarecastle, Miltown Malbay, Kilrush and Lisdoonvarna. These facilities work well. They support the Government policy of retaining people in their homes and communities for the longest possible time. The building blocks exist in various home care packages, the public health nurse facility and home help to ensure people can continue to stay in their homes for as long as possible. Studies demonstrate that people's existence and longevity are enhanced by retaining them in a home setting around their family for as long as possible. It is unfortunate that we are addressing some extent an historic problem, one which will be dealt with in the courts at a later stage. It is wrong that we are now reflecting on one of a number of things that have been gotten right in more recent times in the delivery of health services.

I am pleased to have the opportunity to say a few words on this most important issue. Care and support for the elderly has been always a priority for Fianna Fáil in government. It is regrettable and unfair that the Ombudsman produced such a negative report. One of the most certain things in life is that we will all need care at some point in our lives. If we are honest, every one of us is concerned about how that care may be provided. We may also have concerns about how our parents or other loved ones are cared for. I commend all of the people who commit to the care of a loved one on a 24/7 basis. The care needed may be personal care, meal preparation, assistance to walk and transport for appointments That type of care is vital for many older people.

The policy of this Government is to permit those in need of care to remain in their homes for as long as possible. Through a variety of supports people are enabled to remain independent for longer and can continue to live in familiar surroundings among family, friends and neighbours. Nursing home care becomes necessary when this support is no longer sufficient to safely meet their needs. Community and home-based care is vital and is a major support to families who require support with the demanding work of caring. Home help, home care packages and day care are all community-based services that are vital to supporting people to continue living in their homes.

In 2010, a total of 12 million home help hours and more than 5,000 home care packages will be provided by the Health Service Executive. Day care facilities across the country also play a major role in the lives of those who may require care. I compliment the Minister on the introduction of the nursing homes support scheme and the Health Information and Quality Authority. Those schemes have received widespread welcome and support. We now have a uniform system of financial support for both public and private beds in nursing homes. This new scheme ensures that no one has to sell his or her home to pay for care, that no one has to borrow to fund this cost and that no family will have to find the money elsewhere or mortgage their home to access funds to pay for care. It is regrettable that the Ombudsman's report is so negative. Heretofore, nursing home care was not affordable for many people. We now have a fair system.

Today those who need care and all of us who will require care into the future can look forward to care of a high quality and high standard in public and private nursing homes alike. This Government has maintained its continued commitment to older people. I compliment the Minister on her efforts to balance co-operation with the Ombudsman and her own legal advice.

Tonight's motion deals with nursing home care for the elderly. Having served in the Department for a period as a Minister of State with responsibility for services for older people, I have a particular interest in tonight's debate. During my time in the Department a policy decision was made to introduce the fair deal scheme. The scheme was an honest attempt to deal with what has been a difficult situation. As public representatives, we are all familiar with the difficulties many families encountered when their loved ones were forced to move to private nursing home care. Even in cases where the application for subvention might have been successful there was always a shortfall that had to be met. For many families it was like taking on a second mortgage. It is difficult enough to have a loved one moving out of home into nursing home care — it is a big decision for a family to allow someone else to look after a parent, other family member or relative — but the financial burden that often went with that was an enormous challenge for many families.

As the Minister outlined last night, since the fair deal scheme was introduced more than 16,500 applied and more than 12,250 people were approved. It is welcome to see such a level of take up. One criticism of the scheme however is that people are encountering hidden charges. They go into care on the understanding that their medical and accommodation needs — bed and board — will be looked after, but there are charges for activation programmes, incontinence wear and even laundry services. Those are basic requirements that one would assume would be included. It is important that in future patients and their families know exactly what they are paying for when they go into a nursing home.

We have introduced a number of measures. HIQA has responsibility for the inspections that take place. The quality and standard of nursing homes has improved throughout the country. The regulations on the registration of nursing homes and the care and welfare of residents has resulted in a significant improvement. RTE exposed some of the terrible treatment patients in nursing homes had to endure. That forced the Government to take action.

I single out one Member of the House for the role he played and the interest he took in nursing homes. As a result of the good, solid groundwork he did we took action and brought about a number of improvements. I refer to Deputy Fergus O'Dowd who is not present tonight. I was on the receiving end of his contributions on a number of occasions but as an Opposition spokesperson he served a great purpose at the time.

The setting up of the Office of the Ombudsman was a progressive development. I felt very uneasy while watching the television debate a few nights' ago where the Ombudsman and the Minister for Health and Children were at loggerheads. One would assume the two of them would have the same goal and would be working towards improving the lot of older people. Perhaps we can learn from the Ombudsman's report and that in future we will see greater co-operation between the Department and the Office of the Ombudsman.

The Minister indicated that the budget this year in respect of long-term care for the fair deal scheme and for those remaining in public long-stay facilities and receiving subvention in private facilities would be more than €979 million. Regardless of what is said, unless we deal with the financial crisis we will not be able to provide that level of funding in future years.

I have never seen the public so despondent and angry as they are at present. They have almost lost hope. This country is facing a serious financial crisis. The people are crying out for leadership. Just like the markets they want to be assured that the Government has a credible plan to get us out of this hole. People deserve to be given the full facts and to get an explanation of the exact position we are in, no matter how bad it is. At this stage people are prepared to make the sacrifices and they are expecting the worst. We cannot continue treating people they way we have done. We often speak about our educated electorate, yet on occasion we treat them like fools.

Last week was a poor one for the Government. We failed the people and treated them as if they could not understand the complexities of the financial situation. We engaged in a game of semantics. We started trying to play a cute game about words and what they meant or might mean instead of using the opportunity presented to us following a number of statements on television and radio about the state of the nation and the difficulties we are experiencing. We should have taken that opportunity to explain to people the nation's problems and the way in which we were trying to tackle them. It was the least the people deserved.

I am pleased to be given this opportunity to speak in support of the counter-motion tabled by the Government. Deputy Seán Power raised a number of points that I might address towards the end of my contribution. Regardless of political party, I hope we would all be in agreement that there have been vast improvements in the care of the elderly in recent years. I am not putting this down to political parties.

Day in, day out in my constituency of Dublin North, which I share with Deputy Reilly, access has been given to the fair deal scheme and financial burdens and worries have been removed from families who, because they could not afford to do so previously, have only now had the chance to place their loved ones in nursing homes of their choice. Given that more than 12,250 of 16,000 applications have been approved, the scheme is important. The cornerstone of any political party and mine in particular must be respect and care of the elderly and those in need.

As mentioned by other Deputies, there have been exposés on how care has not met the required standards. This situation cannot recur. The ongoing debate between the Ombudsman's office and the Department of Health and Children and the HSE has been distasteful. We should all have one goal in mind, that is, to offer and provide access to the best care available for elderly people. This provision is predicated on our being in a financial position to continue to fund such schemes, funding which amounts to €979 million this year.

That the Dáil is discussing this matter is important. Fine Gael might view this as an opportunity to row back on a disastrous interview conducted by its leader in respect of the HSE two weeks ago in which he effectively put forward a slash-and-burn vista of HSE job cuts all over the place. I know hundreds of workers in the HSE, as I am sure Deputy Reilly does. They provide home care and work in nursing homes and we need to do our best to support them. We will fall down on some matters, which is the reason we should not just throw out reports like the Ombudsman's. We must consider the issues that have been raised irrespective of whether we agree with the points.

Since we are discussing the HSE and the Minister of State, Deputy John Moloney, is present, I wish to mention care of the elderly. I am concerned that there is a threat hanging over my area of Dublin North as regards the Swords Dublin fire brigade ambulance service. Last year, it carried out 4,500 emergency calls, 30% of which were critical. I hope the HSE and Dublin City Council can reach a financial resolution to ensure this crucial service for the people of Swords, Malahide and surrounding areas receive this ambulance service. Like Deputy Reilly, I took the opportunity to meet the station's crew and staff in the past week or so. The work they do is exceptional. Petty squabbling between the HSE and the city council over funding the service is not on. A sizeable portion of the patients and people the Swords ambulance D134 looks after are elderly, the very people we are discussing. If we cannot provide this emergency service, it does not reflect well on us or the HSE. I do not mean to be too parochial, but this is an example of front line services being important.

I am pleased by the interest that has been shown in the HSE's early retirement and voluntary redundancy schemes for administrative grades. This is not a question of telling people to get out the door. Instead, it is about people making their own choices as to whether they wish to retire early. Our focus must be on the front line, continuing to provide care for the elderly and listening to and taking on board criticism. It is important that we retain the Swords ambulance service for the people of Dublin North.

I am glad to have a few minutes to speak to this important motion and to commend the work that has been done in caring for the elderly and the improvement in recent years. I was a bit alarmed by the debate between the Ombudsman and the HSE. We do not have to believe the Ombudsman is God and that everything she says is perfect. I understand there was great communication between her, her office, the Minister for Health and Children and the Minister's office. Little would separate them, but there was certainly no conspiracy to keep information from the Ombudsman or to shut her out. The Minister needed to take legal advice, as any Minister would, and I understand she followed the Attorney General's advice.

I wish to take the opportunity to discuss a facility in my town, Loughloe House, which Deputy Reilly visited some time ago. He did not tell me he was coming. Otherwise I would have laid out the red carpet.

I must get Deputy O'Rourke's telephone number.

He will visit again and we will welcome him. Loughloe House was built in 1979 as a public home for the elderly supplied by the health authorities. The Health Information and Quality Authority, HIQA, found grave problems. In approximately six weeks, many of the errors HIQA had discovered in its infrastructure had been remedied and Loughloe House is now right in every respect.

Only eight residents remain. It was built for 39, then the number of residents dropped to 29. Everyone got a place wherever they wished inasmuch as they could. It was not always possible, but it was in most instances. The residents' relatives are good and visit them often and they are in receipt of a good quality of care from nursing and visiting medical staff. Thankfully, the deadline for Loughloe House's closure was lifted. Its residents are happy to be there.

While I have the floor and the Minister of State is in attendance, I will mention how there are many idle beds in that fine facility. Nursing home places in the Athlone area are fast running out. Most of the people in question are from Athlone or its hinterland and there is a need for a place that has spare beds. I worked with others to ensure the deadline was lifted and Loughloe House remained open, a situation about which I am glad. While it remains open, it is proper that the elderly who are looking for respite or long-term accommodation be accommodated there. It is a homely place that was built in a modern fashion in 1979 — a square around a quadrangle, which is how it is expected people in elderly accommodation would live. They have views of people in the little bays and wings. It was lovely to be there during the summer and to see those people so happy. I hope we can use the spare beds and that the happy existence of those of the original residents who remain will continue to be accommodated while they live out their lives with daily visits from relatives.

A great deal of good work has been done for the elderly. Every effort is being made to ensure that the good work continues. The fair deal is a great package. It has brought ease of mind not just to many older people, but to their relatives and the wider families who were under a great deal of pressure with regard to what to do with their loved ones.

I am pleased to be able to contribute to this Fine Gael motion, and I commend Deputy Reilly for bringing it forward. There are many issues I could speak about but I will concentrate on a couple.

I happened to see "Prime Time" last week on the Ombudsman's report regarding nursing home care in Ireland and the rights and entitlements of people accessing that care. The message from the programme to the people was to the effect that there is no accountability by this Government and that we are as well not to have an Ombudsman because no account is taken of her views. The Ombudsman has been seen as a fair referee and adjudicator when members of the public are denied their rights by the State. This office has been a great source of comfort for thousands of people all over the country, after other avenues had been exhausted. The then Taoiseach, Garret FitzGerald appointed the first Ombudsman, Michael Mills, in 1984 and since that time all Governments for the most part have, until recently, accepted the findings of this independent voice and that office's recommendations.

The lost at sea scheme was voted down earlier this year in the Joint Committee on Agriculture, Fisheries and Food on the instructions of the Government. Then we had the spectacle last week of the Minister for Health and Children, Deputy Mary Harney, telling the Ombudsman, Ms Emily O'Reilly on live television that she was operating outside her jurisdiction, and justifying the non-co-operation of the Department of Health and Children and the HSE with the investigation. The Minister went on to sing the praises of the nursing home support scheme introduced last year as a way of addressing the issue for the present and into the future. She did not deal with the denial of rights to the elderly in the past nor did she clarify the difference between eligibility for nursing home care and entitlement to it for applicants. This has not yet presented problems because the scheme is only in its early stages and the resources allocated this year have been sufficient to meet the needs of eligible applicants. The number of eligible applicants, however, will mushroom in the coming years as Ireland's population grows older but this does not make elderly people entitled to it if the resources are not in place, so there is another major crisis coming down the tracks.

Therefore, the Government scheme that is being praised by it from on high ignores the injustices of the past while failing to recognise that it is not going to be a solution for the future. With reference to last week's "Prime Time" programme, I would urge that the country cannot continue like this. The Ombudsman's recommendations are either accepted or they are not. Both the Minister and the Ombudsman must consider their positions, following what the public saw on live television last week. Either we have a dictatorship in which we are all told what to do or a democracy where there are checks and balances and within which justice is provided in the system.

The Ombudsman took on the Minister, the Department of Health and Children and the HSE last week on behalf of the senior citizens of Ireland and she was told it was none of her business and advised not to be acting outside her jurisdiction. There has been much talk recently on the need to reform politics and how it is administered in this country inside and outside these Houses. This investigation into the history of how our elderly have been treated and the subsequent report and its handling by Government is a good reason why there has to be a fundamental review of how political business is done in this State, to address the imbalance between the powers of Parliament and the Executive under the Constitution.

There are many issues that I have not time to address, such as the way the State is defending cases being brought by members of the public. No explanation or clarity has been given in that regard, but some of my colleagues have dealt with this already. I want to come back to the fundamental point of the Ombudsman's report and the Department's response. It is startling. The Department said the Ombudsman had exceeded her jurisdiction, failed to abide by fair procedures, displayed prejudice, objective bias and arrogance, while purporting to interpret the law.

On the other hand there is the damning conclusion in the Ombudsman's report which refers, in terms of to access to nursing home care over four decades, to confusion, uncertainty, misinformation, inconsistency and inequity. That is not the view of politicians, but rather the Ombudsman's view. I commend this motion to the House.

I have heard some great debates in this House over the years, but it is seldom one sees a very senior Minister take on an Ombudsman in the manner it happened here last night. I was not actually in the Chamber, but I was listening to it on the monitor upstairs. One would nearly believe the Minister for Health and Children was somehow or another injured or was being libelled in some manner as regards what the Ombudsman had to say. It is very difficult to understand the rationale behind this.

Everybody is now asking about the purpose of the Ombudsman's office, based on this episode, and why it was instituted many years ago. In simple terms, it was to help people obtain their rights under law and to ascertain what people were entitled to. Every public representative that represents a constituency, whether as a Member of the Oireachtas or of a local council spends a great deal of time trying to do just that but we do not have the type of complex powers the Ombudsman has. Only in a rarity of cases will a Minister come in to the House and disown the Office of the Ombudsman. One might get the impression there is a personal type of vendetta against the Ombudsman, given the manner in which the Minister spoke last night.

If there is nothing to hide why would the Minister, the Department and the HSE not stand up and be counted, and open the books? Is it not transparency we are calling for in everything we do, and is it not this very lack of transparency that has landed us where we are today, with the banks gone under and the country in a terrible state? It is because of the lack of transparency and people not coming up to the plate to do what they were supposed to and paid to do.

The same principle applies in this. What shocks me altogether is the apparent gulf between a senior Minister and the Office of the Ombudsman, which is there to protect the rights of every single citizen. That is what the debate is about. I do not know where all that leads to, as such, but one might certainly expect that the questions that were asked should be answered openly and honestly on behalf of every one of the 4 million people in this country.

The big question over the years was what a medical card entitled its owner to. Did it mean, in effect, that he or she was entitled to be a long-stay patient in a public nursing home? In the event that the nursing homes were filled or space was inadequate, what did the medical card entitle its holder to in a private nursing home? These are fundamental questions about which there was no clarity in the past. Even at this stage, people are entitled to be given the answers and to be told where they stand. There are many other issues on which I would like to comment in this vein. This issue has created havoc for families down through the years. As Deputy O'Mahony stated, people need clarity in regard to the law as it stood. For this reason, 300 people have taken actions before the courts. Many more cases may be taken to the courts in order that people can get clarity on this matter.

I was present with Deputy Reilly when the current nursing home support scheme, more commonly referred to as the fair deal legislation, was going through the House. There are many aspects of that scheme I like. However, problems are only now beginning to emerge. It has been brought to my attention that there is a lack of clarity in regard to the eligibility of people aged under 65 years. This matter needs to be clarified. Some people are deemed to be eligible while others are not. It is incumbent on the Minister of State, Deputy Moloney, and the Minister to explain the position to the people concerned.

The standard of care in our public and private nursing homes is increasing year on year. The nursing homes with which I am most familiar are staffed by caring people who provide an excellent service. As I have previously stated, the Health Information and Quality Authority controls in this area are useful in terms of ensuring our nursing homes are well run. Those nursing homes which are well run have no problem with inspections, irrespective of whether they take place during the day or night. We must ensure we have in place controls, such as provided by HIQA, which will ensure every elderly person committed to a nursing home is given the best service available.

Since publication of the Who Cares? report commentary has been dominated by the controversy and dispute between the Office of the Ombudsman and the Department of Health and Children and Health Service Executive. It is important we bear in mind that the Ombudsman has stated that this report is based on more than 1,000 complaints she has received since 1985. It is important we keep that to the fore in this debate. The complaints relate to care in nursing homes, care for elderly patients, complaints from families and patients and those dealing with their affairs in terms of who was providing their care, what were their entitlements and the level of confusion in this regard.

It is difficult to understand what these people were and are entitled to now. There is no clear statement from the Government on how the system will operate in terms of nursing home care. It is understandable, given the role of the Ombudsman, that complaints would be directed towards her from frustrated individuals and that these complaints would be acted upon. The Ombudsman's report is littered with stories from individuals in regard to their financial situation, the distress this has caused and the fact that they found it so difficult to get answers.

Having to find long-term care for one's elderly relatives is difficult for many families. As mentioned by a previous speaker, there are many families who must do this for relatives who are not so elderly but who are incapacitated and must be cared for in a long-term setting. The Ombudsman in her report outlines the difficulties she encountered in getting information from the State and the tardiness with which the State operated in addressing the concerns she raised. The Ombudsman's report, in terms of what followed when the report was published and the relationship between the Health Service Executive, the Department and the Office of the Ombudsman, outlines important issues in regard to the independent role of the Office of the Ombudsman and how the person holding that office should discharge his or her role.

I deal regularly with people facing these issues. Having read the report, it is not clear to what people are entitled. This issue needs to be addressed, particularly given that we are dealing with vulnerable people who rely on others for information. The Ombudsman raised the question of whether there is any enforceable entitlement to be provided when it comes to long-term care. We need clarity and certainty not legislation that is open to different interpretations. It now appears that one's statutory entitlement will not be provided if the resources required to do so are not available. While this is not clearly stated in the legislation, perhaps it should be. We have been promised time and again that the eligibility for health and personal social services Bill, which is at an early stage of drafting, will be published. We need clarity in regard to what people are entitled to in this State when it comes to services provided for them by the HSE, the Department of Health and Children or the State.

Whether one is speaking to someone in the HSE south, HSE south east, HSE national or the Department of Health and Children, the story surrounding the care of elderly people in our nursing homes or hospitals is littered with conflicts and contradictions. The position is not clear. A similar situation prevails with home care packages, in regard to which a completely different approach is taken in different areas. It appears that one's address is often an indication of the type of service or entitlements one can expect to get in one's area.

The nursing home support scheme was introduced 12 months ago. The Ombudsman states in her report that she is aware of much concern in regard to how the scheme is operating. Of particular concern is whether people under 65 years of age in need of long-term care have a right to avail of the service. This issue needs to be clarified. The future of nursing home care is of concern to us all. Will the State provide funding to support the needs of these homes? In 2010, €979 million was allocated for long-term residential care, of which €97 million was released to the fair deal scheme to cover all applicants this year. However, the Minister has stated that given the economic situation, of which we are all aware, she needs to take €1 billion next year from HSE services. Will this result in a reduction in funding to the nursing home support scheme? Are we likely to see a return to long waiting lists, a concern raised in a recent document published by Age Action Ireland? This issue must be addressed.

There are currently a number of legal actions outstanding before the courts. I understand that more than 300 actions have been taken on behalf of people who claim their right to long-term nursing care has not been honoured. What is surprising is that at this stage, none of these cases has gone to a hearing in the High Court despite many of them having been taken more than five years ago. I understand that settlements have been reached in at least a dozen of these cases, the details of which have not been disclosed. This sends out mixed messages and raises questions. Why were these cases settled out of court? Is it an acceptance by the State that these individuals should have been provided with nursing home care by the State and that the costs involved in providing that care should have been funded by the State? How much by way of compensation was paid to the individuals whose cases were settled out of court? What is the position in regard to the hundreds of outstanding cases? Will they be defended or settled out of court? We need answers to these questions. More important, we need clarity in regard to the provision and cost of nursing home care and where individuals stand in terms of their relationship with the State.

I heard part of the Minister's response to this matter last night. It is clear she is at odds with the Ombudsman on many issues. The Ombudsman provided a detailed response tonight to what the Minister had to say last night. While I have not yet had an opportunity to read it in detail I will do so. The Ombudsman is acting on behalf of individuals. The Office of the Ombudsman is an independent body to which people can make complaints and from whom they can seek redress when they believe the State is not providing them with the services to which they are entitled.

I congratulate Deputy Reilly on tabling this important motion. The right and entitlements of nursing home residents has been a key issue in previous contributions and I would like to address the issue in my own constituency. I have been approached by people over the past few weeks whose relatives are in nursing homes and who have had problems with the nursing home support scheme, NHSS. There are significant weaknesses in the legislation and issues that must be addressed.

HIQA does a first-class job. Its staff are professional, focused and good at their work and the vast majority of nursing home owners also do an excellent job but, unfortunately, in the recent past, I have been contacted about two nursing homes in counties Louth and Meath in which significant issues have arisen for a number of my constituents. They are in total conflict with the scheme regarding individual entitlements. The difficulty is no official is in place to vindicate the rights of individuals. HIQA cannot act as an advocate for an individual complainant. The authority has a process under which it will take on board a complaint and send out inspectors but it cannot vindicate an individual's rights.

A citizen of County Louth who is terminally ill is in a nursing home. The man is bed ridden but he is being charged, along with everyone else in the home following a round robin letter to family members, for "outings, social events, music performances, physiotherapy clinics, exercise classes...". The man, unfortunately, will not last much longer, yet his relatives are faced with a bill for more than €1,000 extra per annum for his so-called care. He cannot benefit from these activities. Many other patients in the home with different medical conditions are faced with this demand for €1,000 on top of what they are paying, which is disgraceful.

Another nursing home in County Meath states in its contract of care that services are not covered by the NHSS standard fee. An additional fee of €40 per week covers a number of costs, including personal laundry. There is a dispute as to whether clients should pay for their personal laundry. A letter from the principal services officer for older people to the chief inspector of HIQA states clearly that laundry services are expressly included in the NHSS and, therefore, this charge should not apply. The family of the resident to whom I refer has been instructed to take him out of the nursing home. He is being kicked out of the home because his family is contesting an additional fee for something they are paying for. I am deeply concerned about this because these people are being ripped off. The patients are unwell and they are being put under significant emotional and financial pressure. They are supposed to be cared for properly, yet the nursing homes that have been brought to my attention are breaking the law.

The Minister of State needs to provide a new mandate in legislation whereby HIQA can hold nursing homes to account on the basis of individual complaints. I am informed by the authority that its staff can only take on board what they see and hear during inspections. Immediate action is need to stop this appalling rip-off of sick and terminally ill patients. These are not two isolated cases. The letter from the principal officer in the Department states:

The Department has recently received a number of queries from families of residents in nursing homes. These also centre on uncertainty regarding the fees due and payable by residents of nursing homes. The Department is concerned that a number of nursing homes may be breaching both the regulations and the standards.

It is over to the Minister of State to act and to amend the law. We will facilitate that but he must vindicate the rights of the sickest and most vulnerable in our society when they are being ripped off in such an appalling manner by unscrupulous nursing home owners.

I thank Deputy Reilly for bringing this important issue to the attention of the House. It addresses two issues, the integrity of the Office of the Ombudsman and the right of vulnerable people and their families to use the facility of this office in the belief that they will secure a fair determination. We have witnessed a concerted effort by the Government, the HSE and the Department of Health and Children to undermine the Ombudsman. If this was a one-off event, we would say we have to do something about this but this is a case of déjà vu in the context of the behaviour of the Government towards the Ombudsman. Recently, I proposed, as Fine Gael agriculture spokesperson, that the lost at sea scheme report by the Ombudsman be accepted by the Joint Committee on Agriculture, Fisheries and Food. Unfortunately, the Government sought to kill it and to bury it once and for all even though the facts are quite clear.

The Ombudsman has defended her position in so far as she was asked to ascertain the difficulties that families had in getting long-term residential care for family members; to determine the stress that caused; to outline and highlight the tardiness in the way they were deal with by the Government; and to see if there is any onus on the Department or the HSE to recognise their level of governance was inadequate. Unfortunately, we have had a concerted attempt to undermine the Ombudsman, who forwarded a rebuttal document to us this evening. It is lengthy and it was impossible to digest it before the debate.

However, her original report has come at an inconvenient time for the Department and the HSE. There is a plan, which is not stated anywhere in policy, to take care of the elderly out of the public sector. There is a determined effort to wind down the service using HIQA to starve excellent nursing homes all over the country of the resources they need to bring their facilities up to standard. The authority is being used as the cannonball to close them down. I witnessed a belt and braces job in this regard in Wicklow town in my constituency. After years of working in consultation and co-operation with local people, who had raised hundreds of thousands of euro to support the local nursing home, a policy initiative was taken to close it. A recently published HIQA report and a fire safety report confirmed there was no rationale behind this decision. There was no communication with the residents or their families. The final patient was removed last week following considerable distress, given the nearest facility is 10 km from the town.

We were informed the fair deal scheme would be a wonderful panacea for everybody but it does not compare like with like. Issues have not been addressed and, for example, Deputy O'Dowd outlined hidden charges. While many of the nursing homes are good, everything is up for grabs and they provide facilities on a pay per use basis. No effort was made to refine and reform public service provision, which could provide every bit as good a service, if it was addressed.

At the end of the day, this comes down to the public's belief that the Ombudsman's office can be used to determine whether the State has been fair regarding issues they have. If it is to be rejected because it is inconvenient, we must question the point of having an Ombudsman at all.

At the outset I thank all Deputies who contributed to the debate. A number of Deputies have recognised the contribution of Deputy Fergus O'Dowd and I will also do so. I also recognise the number of years in which he has had an interest in the area. I ask Deputies to consider the involvement and interest of the Minister for Health and Children, Deputy Mary Harney, in the care of the elderly. The debate is not about the fair deal scheme or HIQA standards but it is worth remembering that whenever the Minister came before the Oireachtas committee dealing with health, they were the main issues on her agenda. The fair deal scheme has been an answer to a very difficult problem.

Many people this evening have based their thinking and speeches on the "Prime Time" programme, using words such as vendetta, personal animosity and others which belittle the debate. In this context I recognise the significant ability of the Minister for Health and Children and the Ombudsman. By coincidence, the Ombudsman's mother hails from my hometown — I know the lady quite well — and the first Ombudsman also came from Mountmellick. Notwithstanding such facts, it is very important to deal with this evening's issue.

Many Deputies feel this is an attack on democracy and people have even suggested it is a dictatorship. To my mind the Minister was purely refuting the allegations made by the Ombudsman that her Department failed to co-operate with the investigation. I will use the few minutes I have to respond to this.

Anybody who reads the Department's submissions and correspondence with the Ombudsman, which are freely available on the Department's website, will see that the Department made it clear on many occasions that it was available to fully co-operate with the Ombudsman in respect of any investigation within the parameters of the 1980 Act. It is worth repeating the concerns outlined by the Minister to the House last evening regarding the content, scope and language of the report, as well as the way the investigation was undertaken and how its conclusions were disseminated via the media. That is a very fair position to take and does not seek to diminish the Ombudsman's report; importantly, it brings clarity to the Government's position. I underline that it was not an attempt to hide, as has been alleged.

In order to bring balance to the debate, the Government at all times sought to balance co-operation with the Ombudsman with legal advice, as advised by the Ombudsman in other contexts. There was also the issue of a right to defend the State against any litigation. Many people have made the point that the Ombudsman is somehow above the State in the defence of citizens but surely the Minister has equal entitlement by way of defending the State against litigation.

It is unfair that the Ombudsman would seek to portray this in such a negative and conspiratorial light, and that is where our difficulties lie. There was no attempt to be conspiratorial and, importantly, there was an attempt to be open. The Government made the point that the Ombudsman followed fair procedures in notification of subsequent investigations of the matter. There was a refusal to supply the Department with a full report or, initially, anything more than a five page summary. Comments made during the investigation by the Ombudsman clearly showed judgments had been reached and opinions formed prior to any final report or request for response from the Department.

The report states that in a letter to the Department of 25 September 2009, the Ombudsman clarified that the actions being investigated did not include the Department's handling of the litigation concerning the right to be provided with inpatient services. The Ombudsman rejected any suggestion that she acted outside her jurisdiction in undertaking this investigation and in defence of her own view she refers to what public sector ombudsman offices in other countries do, although I do not see the relevance of that, as well as what Irish Ombudsmen have done for years. As with the nursing home charges issue, a long-standing practice may still be ultra vires. Regarding what the Ombudsman states is implicit in the ombudsman model adopted by the Oireachtas in 1980, the position seems somewhat at odds with her contention that the Department has disregarded the plain meaning of the wording of the 1970 Act.

It is important to make the point that the Ombudsman has stated her investigation is based on many complaints received over 25 years. There were an average of 48 complaints per year on nursing home type care. It is important that this be seen in the context of an average nursing home population in excess of 20,000 in recent years. I wish I had more time to put further explanations but I am thankful for my opportunity to contribute.

Deputy Catherine Byrne is sharing time with Deputies Neville and Reilly.

I thank Deputy Reilly for bringing this motion before the House this evening. I commend the Ombudsman, Ms Emily O'Reilly, on her investigation into the rights to nursing home care in Ireland. She provides a voice for those people who find fault with the State's service and want answers, and she must be allowed to question Government policy in this and other areas. It is very worrying that the Department of Health and Children and the HSE did not fully co-operate with the investigation.

In 2004 there was a major scandal where elderly medical card holders had been illegally charged nursing home fees for many years. The new report shows that once again the elderly have fallen victim to the bad management and administration of the health service. This report, suitably titled Who Cares? An Investigation into the Right to Nursing Home Care in Ireland, examines the case of more than 1,000 older people who since 1985 could not access State nursing homes. These people were forced to go to private nursing homes to avail of care at significant cost to themselves and their families. It is appalling to read that so many people were denied the basic right to nursing home care in their communities in the State.

Making the decision to place a loved one in care is very difficult, and none of us wants to see elderly parents or relatives having to move to a nursing home, likely not to return home. We want our loved ones to be kept close to us, where we can care for them surrounded by neighbours and friends.

When things go wrong, difficulties can arise, with illnesses involving dementia or physical disabilities in particular becoming so serious that help is required. People seek the best place to ensure loved ones receive the best of care so that they do not become just a number in a nursing home. We want these people to feel comfortable and treated like real human beings rather than left sitting in a chair all day. We want our loved ones to be included in activities if possible and remain suitably alert and active for the time spent in these facilities. Above all, they should not feel institutionalised or left alone. We want to be able to visit them often and preserve a sense of family. We should not forget those elderly people who do not have extended family to visit them, and who are at risk of being isolated because they have been removed from their home and community, where neighbours and friends call in on a regular basis. Such people are especially vulnerable.

Currently there are approximately 23,000 people in long-stay residential care in Ireland, with a third of them in public homes. Public long-stay beds have dwindled in numbers, as indicated by other speakers, and are being replaced by private nursing homes. They have lost funding and many have had to close. The future of public nursing homes seems very bleak and I want to know what the Minister, Deputy Harney, is planning for their future.

Like many people who work in communities and who care for people in their own homes, I believe the way forward is independent living. We must keep elderly people at home in the area where they live or have grown up, where there is a link with families and friends. Many elderly people only need a little helping hand to live well enough in their homes into their 80s and 90s. Most elderly people want to be close to families and friends and be part of the community. They like to be able to keep independence and dignity above all. However, to properly support these people living at home we need the necessary services on the ground, such as public health nurses, social workers, physiotherapists and, above all, home help. These services have been cut throughout the country and it is having a devastating impact on community care. The Government needs to realise that investing in vital services in our communities at the level we want will save the State millions of euro.

I welcome the opportunity to contribute and congratulate Deputy Reilly for introducing the motion. The Government has ignored the rights of the elderly. It does not recognise their contribution and the treatment of the Ombudsman's office reflects this. The Office of the Ombudsman was set up as an independent, objective voice on behalf of the citizen. When the Bill was introduced, I remember that Fianna Fáil resisted it at every turn because it did not want an objective response and evaluation of the decisions made. The office gives an objective opinion and recommendations outside of politics but the Government is threatening the status of this office, which it wants to undermine.

The Ombudsman has highlighted the difficulties experienced by the families of people in nursing homes, including financial difficulties. Many in nursing homes have been failed by the State. The health boards and the Department have failed these people and their families in regard to their duties under the law. This is the focus of the motion. The criticisms of HIQA and the standard of inspection of nursing homes are misplaced. It is one year since the inspection regime was set up and two of its objectives are to change the culture of care and to raise standards in nursing homes. A nursing home should be a home from home, not a geriatric ward.

On the issue of restraint, many nursing homes never use restraint but some do. Raising the standards of the HIQA inspection process will improve standards throughout the nursing home regime, which will contribute to a better quality of life and more of a home from home atmosphere in our nursing homes.

The Minister of State, Deputy Moloney, must consider the issue of brain injury and mental health impairment among young people resident in nursing homes. These people are conditioned to respond like geriatrics in their latter years. It is inappropriate that young people with brain injury or intellectual difficulties should be in nursing homes. There should be dedicated services for people in such a position. Nursing homes should meet people's needs rather than seeing them only as an investment for the proprietor, although the trend is moving in that direction.

On the issue of the geriatric elderly in mental institutions, it is totally inappropriate that those who are elderly and require nursing home care are in psychiatric institutions. I understand that at present there are 1,000 people — I say "people" as they are probably no longer patients — in long-stay psychiatric homes who should effectively be in a nursing home environment because they no longer need the psychiatric intervention they previously needed. Many are elderly, long-term patients and in some ways they are in the homes for social reasons. This also applies to intellectually challenged people who are in long-stay psychiatric nursing homes. It is an issue that needs be addressed. I have costed the saving to the mental health services, in which I know the Minister of State, Deputy Moloney, is interested, and this would be well over €35 million.

I thank all those who contributed to the debate. From what the Minister said yesterday, I would like to know what information the Ombudsman sought in 2009 but which was not supplied and was ultra vires, according to the Minister. The Minister also referred yesterday to the good people working in the Department of Health and Children, of whom I know there are many. However, I would like a reassurance that none of those in the Department of Health and Children who dealt with this issue were those who dealt with the medical card issue, as they certainly did not serve the public in a manner in which they should have in colluding with successive Governments to deprive people of care to which they were entitled.

Deputy Mary O'Rourke referred earlier to Loughloe House, which I visited. As I recall, a HIQA report itemised ten issues around that situation, many of which concerned staff and management, not the building itself, yet it was used as an excuse to begin to move people out of it, despite the fact that they considered it to be their home and without consideration for the relationships they had formed. I have a clear memory of one man who shares my name who suffered a stroke not long afterwards due to the stress he was put under, yet the HSE continued to move out the people.

One of my colleagues raised the issue of privatisation in regard to the Dublin fire brigade service. That is the approach of the HSE. When HIQA identified problems with a service, instead of fixing it, the HSE closed it down. On the Dublin fire brigade issue, it is a question of money being paid over for the services provided by Dublin City Council and, instead of fixing it, the answer is to close it down and deprive people of an essential service because the State will not pay the money. Other speakers made the point that 20 years ago there were twice as many people in public facilities as in private but it is now the reverse.

I congratulate the Ombudsman and her office and I commend her courage. Equally, however, I abhor the Minister's attack on the Ombudsman and her office, in which she engaged again yesterday. It is an office that defends people against this opaque Government and its servants. All we need do is look at the extraordinary behaviour of the Taoiseach and his Ministers in the past week, denying the reality of the economic mess the country and the rest of the world sees reported but which the Minister, Deputy Dermot Ahern, sees as fiction. It is fiction on a Sunday and fact on a Thursday. He and his buddy, the Minister, Deputy Noel Dempsey, decry any knowledge of the impending bailout by the ECB and the IMF of the country's economy, which has been wrecked by the Tweedledee and Tweedledum of the two Brians.

The Ombudsman's office is one of the few remaining champions of the people. She highlighted in her report the lack of clarity in the law as it stands, and stated that while the nursing home support scheme might clarify eligibility, it does not clarify the situation regarding entitlement. She continued by stating that poor legislation will be exploited in the courts, and the 400 cases before the courts are evidence of this.

Questions remain. Will the nursing homes support scheme fund of €970 million remain untouched by this year's budget? Will we again see waiting lists for nursing home care if the money runs out? Other speakers referred to the nearly 2,000 people under the age of 65, such as those with early dementia, brain injury and other debilitating illnesses, whose entitlements are not clear. We must get clarity on the entitlements of such people. This can be done through legislation. There is a Bill dealing with eligibility for services which could address this and it should be brought before the Dáil as soon as possible.

Ireland and its people face the darkest hour since the foundation of the State. Our people are anxious and worried, and many are not sleeping due to great uncertainty created by the disastrous policies of the Fianna Fáil-Green Government. They are flabbergasted by the self-delusion of the Taoiseach and his Ministers and their denial of the truth. They become more disheartened when they see a people's champion, the Ombudsman, attacked and denigrated by Government.

I have a message of hope for the people. We will regain our Republic, rebuild our economy and get our people back to work but we need a general election to put in place a new Government that will give the leadership to do this, leadership that is clear and committed to the good of the country. Such a Government would protect the office and independence of the Ombudsman, the rights of older people and all those who need long-term care. I commend the motion to the House.

Amendment put.
The Dáil divided: Tá, 75; Níl, 64.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Cyprian.
  • Brady, Johnny.
  • Browne, John.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gogarty, Paul.
  • Gormley, John.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Killeen, Tony.
  • Kitt, Michael P.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McEllistrim, Thomas.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • 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’Donoghue, John.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Edward.
  • 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.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Barrett, Seán.
  • Behan, Joe.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • D’Arcy, Michael.
  • Deasy, John.
  • Doyle, Andrew.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Hayes, Brian.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGrath, Finian.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Mahony, John.
  • O’Sullivan, Jan.
  • O’Sullivan, Maureen.
  • Penrose, Willie.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P.J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Joe Carey and Joe Costello.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 75; Níl, 64.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Cyprian.
  • Brady, Johnny.
  • Browne, John.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gogarty, Paul.
  • Gormley, John.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Killeen, Tony.
  • Kitt, Michael P.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McEllistrim, Thomas.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • 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’Donoghue, John.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Edward.
  • 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.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Barrett, Seán.
  • Behan, Joe.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burke, Ulick.
  • Burton, Joan.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • D’Arcy, Michael.
  • Deasy, John.
  • Doyle, Andrew.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Hayes, Brian.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGrath, Finian.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Mahony, John.
  • O’Sullivan, Jan.
  • O’Sullivan, Maureen.
  • Penrose, Willie.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P.J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies John Cregan and John Curran; Níl, Deputies Joe Carey and Joe Costello.
Question declared carried.
Barr
Roinn