I thank the Deputies for all their contributions today. Debates like these are important so that we can all reflect on how the State is currently supporting its citizens, highlight deficiencies in past approaches, particularly those affecting the vulnerable, and ensure this knowledge and learning is used to inform improvements into the future.
Today the focus has been on two essential elements of our social care system, namely, services for older people and services for those with a disability. As Minister of State with responsibility for older people, my priority has always been to ensure our older people get the best care possible. For many, that care can be provided in their own homes surrounded by the people and communities they love. The Government remains committed to supporting people to age in place at home in their community with access to wraparound supports, including daycare and dementia-specific daycare services, meals on wheels and home care. We are also pursuing a significant reform programme for home care which will see the introduction of a regulatory framework for the first time and will deliver equitable access to high-quality services based on a person's assessed care needs.
Most older people wish to remain in their homes and communities for as long as they are able, and it is certainly Government policy to support this and something we feel strongly about. That being said, there will always be a cohort of people who require access to quality long-term residential care. Within this context, the nursing homes support scheme, NHSS, established in 2009, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The scheme aims to ensure long-term nursing home care is accessible and affordable for everyone and people are cared for in the most appropriate settings. The scheme provides a universal and transparent system of support that is fair to all, irrespective of whether they are in public, private or voluntary nursing homes. With a total budget of €1.094 billion in 2023, the NHSS supports about 22,500 people in long-term residential care.
However, this was not always the case and this has been well discussed today. We are all agreed that the previous dual system of funding for public and private nursing home care was unequal and unfair, but it was the prevailing policy at the time and it was a reflection of the financial constraints governments were operating under at the time. The issues raised over the past week are not new and have been the subject of significant debate both in the Oireachtas and in the media over many years. This includes during the 2004 to 2006 period following the Travers report and the Supreme Court judgment, during legislative debates to regularise the charging regime, and again in 2010 with the publication of the Ombudsman's report on the right to nursing home care in Ireland. It was accepted in 2004 that there was no legal basis for charging those in publicly funded care with full eligibility. This was regularised by the introduction of legislation in 2005 to provide for charges in publicly funded care and the establishment of a repayment scheme to refund charges that had been paid pre-2005.
It is important to emphasise again that the scope of the scheme was well publicised and limited to those who had full eligibility under the 1970 Act and who had paid charges to the State for publicly funded care. Persons who had paid fees in private nursing homes were not eligible to apply. As we know, many people have taken legal challenges relating to claims that the State failed to provide nursing home care in private nursing homes free of charge. At all times, the consistent policy of my Department has been that any eligibility under the 1970 Act was, and continues to be, subject to the availability of resources. The reality is the State always has limited resources to fund health services along with all the other necessary services it has to provide for the benefit of its citizens. This position was set out quite clearly in a countermotion by the Government in 2010 that explicitly stated 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". Yes, the system that was in place from the 1970s up to 2009 was unequal but that does not mean the State did not meet its legal obligations or that there was a right for people in private nursing homes to have their care funded by the State.
The current Attorney General has advised that the legal advice furnished in respect of the litigation concerning charges levied for private nursing home care was sound, accurate and appropriate; that there is and was a bona fide legal defence to these cases; that the approach adopted by the Department was justified; and that the Department acted prudently in settling claims.
I will now turn to matters relating to the disabled persons maintenance allowance, DPMA. Again, these issues relate to an extended time period going back almost 70 years.
The historic policy with regard to eligibility for the DPMA remained largely unchanged from the 1950s to 1999. The intention of the DPMA was to provide a defined weekly rate of payment for eligible recipients living in the community. A clear and logical distinction was made between the financial needs of those living in the community in their own homes and those living in a State-provided residential care environment. As was noted by the Minister in his opening remarks, the policy at that time was such that the State would provide for people with disabilities either through in-kind support, that is, maintenance in a residential facility, or through financial support for people living in the community but not both. As we are aware, eligibility was expanded over a period, starting in the 1990s. The restrictions applying to people living in long-term care and receiving the disability allowance, formerly the disabled persons maintenance allowance, were finally abolished in January 2007 for those who would otherwise be entitled to it.
Allied to this and similar to the situation in regard to nursing homes, it is a long-standing policy position that people in receipt of publicly funded residential care would make a contribution towards the cost of their care or maintenance. The residential support services maintenance and accommodation contribution, RSSMAC, provides the framework for the management of such means-tested contributions in residential facilities managed by the HSE or by section 38 organisations on behalf of the HSE. The collection of contributions under the RSSMAC framework commenced on 1 January 2017. The RSSMAC ensures service users make an affordable contribution to their maintenance and accommodation costs while retaining a sufficient level of income for personal use and to meet their personal financial commitments.
In speaking about residential care for people with disabilities, it would be remiss of me not to refer to Transforming Lives, the national collaborative effort to build better services for people with disabilities. More particularly, it is important to acknowledge the 2011 report, Time to Move on from Congregated Settings: A Strategy for Community Inclusion, and the programme of decongregation under way. The policy objective being pursued means that, since 2011, people with disabilities have been supported to move from large institutions to their own homes in communities with the supports they need. This has resulted in the number of people living in congregated settings being halved over the past decade. It is acknowledged, however, that there will always be a cohort of people for whom care in a residential facility is optimal, and today approximately 8,200 persons with disabilities live in such facilities. The pursued model centres on supporting people to "live ordinary lives in ordinary places", in ordinary homes in the community, and almost three quarters of people living in disability residential care are now in houses located in the community.
Our current policy on residential care is informed by Article 19 of the United Nations Convention on the Rights of Persons with Disabilities. Indeed, Ireland's ratification of this UN convention in March 2018 was a strong signal of our commitment to improving the lives of people with disabilities and an important milestone in a continual process to strengthen and raise awareness of their rights.
The Government takes seriously the issues raised in respect of historical nursing home charges and the disabled persons maintenance allowance. The report of the Attorney General provides us with a comprehensive account of these issues. Notwithstanding the assurances provided by his report, as a further step in this process, the Minister for Health and Minister for Social Protection have undertaken to consider the report in full and revert to the Government in three months regarding any further steps that are required.