Fair Deal Nursing Home Scheme: Statements (Resumed)

I would like to share my time with Senator Mullen.

I thank the Minister of State for her words on this scheme and it was interesting to hear them. I did not know much about nursing homes, but my mother-in-law went into one last year. It was the last year of her life and she died last month at the age of 101 and a half years. We were counting half birthdays by that stage. While she was not involved in the fair deal scheme, I was impressed by the service and attention she received. I also got to know a number of people who were in the nursing home under the fair deal scheme. The concept was a good one.

The Minister of State has given an explanation. What has happened is shocking. The Minister of State referred to the €100 million that should have been allocated to the scheme but was instead allocated to therapies and drugs. I do not know what would be done in the health service, but if such occurred in a private enterprise, heads would roll and there would be an outcry. I am sure the Government has taken steps to solve the problem, but that it could happen at all is of concern.

I wish to speak in broader terms. I am concerned about care for older people. A new report conducted by the Saga Group, a company that markets to older people and others, highlights the vast differences in social care spending for the elderly throughout the EU. Of the 20 countries surveyed, Italy spends the most and Ireland the least. Italy and France spend more than 11% of GDP on services for seniors, which shows that those nations have some of the best policies for the aging boomer population. At the other end of the scale are the UK with5.8%, the Netherlands with 5.3% and — guess where we come in — Ireland, last with 3.1% of GDP spent on the elderly. With so little funding to provide assistance for older adults, some experts speculate that these nations will be prone to deeper care problems in the near future. With fewer initiatives in place, seniors have a more difficult time getting help in their day-to-day lives. This is a stark situation when one considers the findings of a new EUROSTAT survey. According to it, people aged over 65 years of age will account for 22% of Ireland's population by 2060, with those aged over 80 years representing 12%. The former is double the current figure of approximately 11%. We must take steps to take the long term into account.

A report published by the Department of Finance last April concerned me. It identified the expected explosion in the number of older citizens as a significant problem for long-term financial stability. The report claimed the situation would result in increased public expenditure. An aging population can cause problems for a country if the working population is not large enough to support the welfare of the elderly. The report read: "Projections indicate that public spending on pensions, health and long-term care will increase from 12 per cent of GDP in 2007 to 15 per cent by 2030 and to 21 per cent by 2060". The report also said that potential savings from education expenditure will contribute only a small offsetting amount and that as a result, steps taken could include increasing the population at work, cutting age-related spending and improving the country's productive capacity. How can we consider cutting age-related spending when we spend the least in Europe? The situation seems to be laying the foundations of a much larger problem.

What is the Minister of State's opinion on assisted living accommodation? Ireland does not seem to have gone in this direction, unlike the United States of America where assisted living communities are commonplace. Many people do not need to live in nursing homes and only need a little bit of help. They could live independently and the ratio of nurses to older people would be low. In the long term, we need to move from a nursing home-oriented system to one in which people either stay at home or in assisted living communities, as Senator White suggested. Consider the raft of apartment blocks owned by the National Asset Management Agency, NAMA. Instead of nursing homes, would they not be ideal for those who, with just a little help, could live on their own? Could this not reduce the cost to the State of providing nursing care? It would appear to incur a lower cost and be more appreciated. My mother-in-law preferred to stay at home and it was not until the very end that she was not able to.

The cost of private nursing homes has increased by approximately 4% this year. If we started assisted living communities, we could contribute to the solution.

I would be interested in the Minister of State's opinions on this subject. We must take the long-term approach. The fair deal concept was ideal. Although we need to make something like it work, we need to find a better solution for the long term more so.

Gabhaim buíochas leis an Seanadóir Quinn as ucht a chuid ama a roinnt liom. Cuirim fáilte roimh an Aire Stáit. I have welcomed the Minister of State to the House previously. If she pardons me, I will start on a slightly negative note, in that it would be helpful if we could be supplied with ministerial speeches earlier in the proceedings. She had interesting comments to make and Senators will want to respond. It would be wonderful if members of the Government would circulate speeches days in advance. This would seem to create a somewhat artificial situation but, as Ministers and Ministers of State generally speak from prepared notes, having an idea of what they will say would be useful for Members. The point of the exercise is for us to make representations and proposals to the Government and for the Government to respond. It is not the Minister of State's fault, but I would be grateful if she took this message with her. I am concerned about the speech because I noted the Minister of State's comments regarding the fair deal nursing home scheme and the €100 million that seems to have been spent elsewhere, with only €48 million being spent on the scheme. This chaos is troubling people.

Approximately €1 billion has been allocated for nursing home support. According to one programme I heard, though, some €1.5 billion will be required. If so, will there be enough money to fund the system for everyone who needs it? One must be concerned about the HSE's modus operandi, given the spending of money under the wrong heading. However, another concern relates to the apparent serious discrepancy between private and public nursing home costs. According to some reports, private nursing homes cost up to 50% less than their public equivalents. The Minister was correct about this being an unsustainable situation, one that points to a lack of efficiency and value for money within the public service. If so, why does the Minister’s focus appear to be on reducing costs in the private sector? Saving €20 million would be great, but greater savings might be made by addressing the public provision of nursing home care.

While the train has left the station to some extent, Professor Des O'Neill, a gerontologist and someone whose opinions on this matter we should take seriously, has raised an important issue, namely, the difference in attitudes towards funding long-term nursing home care for older persons and other types of care, such as cancer care — an expert in this field is a Senator — and coronary care. People are required to stump up for nursing home care with their private property, a scenario never envisaged in respect of the other types of health care. Professor O'Neill has referred to the fair deal scheme as the great candy snatch of the 21st century. Is it not dangerous that the State is endorsing an approach whereby the frailest and most complex group of people in society — I do not mean this in a disparaging sense, as I am only referring to their needs — are seen as a soft touch across the board and are not receiving equality of treatment with other illness groupings, for example, sufferers of cancer and heart disease? We need to discuss this issue. A question must be asked about the underlying philosophy of our approach.

Yesterday was World Elder Abuse Awareness Day. Although a related matter is before the courts, I ask the Minister of State about the current controversy. Is it not frightening that a controversy has arisen about a home that the Health Information and Quality Authority, HIQA, investigated and deemed not to have any problem? If HIQA orders a home to close, must people be removed from a setting where, whatever its faults, they are comfortable? Should we not consider an examinership system whereby someone could take charge of and run the home? Perhaps this is already the case, but a certain amount of confusion is caused in the public's mind when people are told of HIQA securing an order to close down a home. I wonder about the impact of such an order on residents. Perhaps the Minister of State could explain the situation to us.

I wish to raise an issue of concern to older persons in care. Recently, a woman wrote to me about what she called the appalling practice in our hospitals of having male and female patients in the same ward. She described how a person aged 92 admitted to Beaumont Hospital was nursed in a six-bed ward with five men. When she brought this to the attention of one of the managers she was told the person was probably not aware of her surroundings, which, again, shows a certain underlying attitude. Another lady brought to an accident and emergency department in the middle of the night suffering with high blood pressure was placed on a trolley in a big open ward with a man on either side of her, one of whom was disoriented and kept putting out his hand and touching her. My correspondent adds, in a somewhat dry aside, that this treatment was not conducive to lower the woman's blood pressure. I do not wish to trivialise this matter. An issue arises in regard to how we are treating people in full-time care. I raise this issue in the context of hospice friendly hospital care.

I accept this matter is not directly related to the fair deal scheme but this debate provides us with an opportunity to raise issues and touch on human dignity in the context of the care of older persons. Perhaps the Minister will today or at a later stage set out the Government's attitude to men and women being put into full-time hospital care settings in a manner that is not conducive to their dignity or, at least, does not honour their wishes.

I wish to share time with Senator Mary Moran.

Is that agreed? Agreed.

I welcome the Minister of State, Deputy Lynch, to the Chamber. It is great to see my constituency and party colleague, friend and neighbour in the House. We could perhaps sort out this matter over a cup of coffee in Blackpool shopping centre.

I welcome the opportunity to discuss the fair deal scheme, which since its introduction in 2009 has been portrayed and widely viewed as the solution to an ongoing problem of securing certainty of delivery of services in residential care for older people. It was warmly welcomed at the time by all sides that the HSE would provide a level of funding for the scheme each year, which it was hoped would be sufficient to support all those wishing to avail of it. However, reports in the media, which I accept the Minister has addressed today, that the fair deal has run out of money, while disturbing, are not entirely unpredictable. The crisis in the fair deal scheme represents the latest in a series of crises that has bedevilled the HSE since its inception. At the core of the problem is a contradictory set of public policy assumptions. Policy decisions on health care provision are often contradictory and seldom coherent.

Deliberate political policy decision-making has led us to where we are now. We have a highly disordered health service, not because the previous Health Minister's policies have failed but because they have succeeded, leaving us with the mess we are now in. The model favoured by the previous Government was flawed in that no serious attempt was made to properly restructure the service when the HSE was established. Policy goals were not identified nor were they communicated within the structure or to the general public. We see examples of this throughout the entire service. For example, in mental health services, there is a contradiction in the Department's stated goal to deliver services in the community. One objective, outlined in a plan drawn up 27 years ago, Planning for the Future, has still not been implemented. We can see coherent policy outcomes emerging in the cancer services area, but this seems to be the exception more than the rule. While in the 1980s and 1990s we might have been able to blame a lack of resources for this failure, this argument fails when we consider the economic success enjoyed by this country in the early years of this decade.

Services for older people are a good example of policy confusion. We often hear the population of older people referred to as a single homogenous group. However, we know, or at least we should know, that older people bring with them all the advantages and disadvantages built up over the course of their lives. Therefore, a one-size-fits-all solution is not appropriate. Older people are often seen as a group to whom things need to be done. Again, there is a failure to see the diversity in value that older people represent. It is unfortunate that in some public comment there appears to be the underlying thought that older people are a burden. We need to consider our own views of older people and must come to recognise older people as valuable and a valued part of our community.

My colleague, Senator John Kelly, reminded me yesterday evening that many older people in residential care would prefer not to be there. The stated objective of the HSE service plan is to maintain older people in their homes for as long as possible. However, the incoherence at the heart of health policy makes this almost impossible to achieve. Funding arrangements for social care in Ireland have the effect of skewing demand for long-term care in the direction of the residential option. The services available to older people are dispersed across a wide range of often unlinked schemes, including the fair deal scheme, home care packages, home help services, day care services, residential services and carers, a group much under-appreciated by the system. It might be thought odd to talk about restructuring the services at a time when the country is facing economic challenges but a coherent and new policy direction cannot just deliver a better service for our older people but would be economically more efficient.

As Labour Party spokesperson on health, I have much more to say on this issue but, perhaps, not today. The Seanad has an important role to play in discussing medium to long-term policy and health policy is a good place to start. I have only barely scratched the surface of this issue and this House could usefully devote more time to discuss it.

I, too, welcome the Minister of State, Deputy Lynch, to the Chamber. When introduced, the nursing home support scheme was seen as a solution to a long-term problem and an ongoing concern for older people and their families. The former Minister for Health and Children, Ms Harney, stated that it was designed to be accessible, affordable and anxiety free. However, less than two years later the fair deal scheme is in crisis. Undoubtedly, the scheme serves an important function. Under the fair deal scheme, there are currently 11,836 people in receipt of State support towards the cost of care in private nursing homes while a further 4,225 people remain on subvention or in contract beds. Approximately 6,400 people are in public beds in public nursing homes, bringing the total number of people in receipt of support to more than 22,000.

The budget for the scheme is more than €1 billion. As Senator Colm Burke stated, currently 11% of the population are aged over 65 years. We need to plan ahead for the next 20 years when the situation will be grossly different. One can only imagine the worry experienced by older people and their families when they heard the fair deal scheme might be in trouble. This situation must be clarified quickly. Reports in the media state that funding for the scheme has run out. However, the HSE has confirmed that nothing will change for those people already funded. New applications will continue to be accepted and processed. However, alarmingly, the HSE has added that approval for new applicants is subject to the availability of funding, a constant cause for concern.

Older people are also concerned — I have received several queries in this regard in recent days — that if the funding is not available, the scheme will be closed to new applicants. Will we be back to the days of waiting lists? Are there other options available to older people and their families? While there are, none is appropriate. Senator Quinn referred to assisted living. There is an excellent assisted living system in Dundalk called the Great Northern Haven. It comprises 16 houses and is a collaboration between Louth County Council, Dundalk Town Council, the HSE north east and Dundalk Institute of Technology. It utilises cutting edge technologies to enable older people to live independently for longer, which is the aim of all of us.

Older people have asked me if they will have to wait for a bed to become available or if they will be left with the stark choice of having to pay the full cost of private nursing home care, at a cost of more than €1,200 per week in some cases, which is clearly not affordable for the vast majority of our citizens.

There is also a concern that many of our older people will end up inappropriately placed in hospital, which is unacceptable and also results in further pressure being placed on the already stretched health system.

At this point, I refer to a case with which I am dealing where an elderly lady, despite trying to live independently for as long as possible, has now reconciled herself to the fact that she requires nursing home care. It is traumatic for any family to accept that the time has come to place a loved one in a nursing home. This lady applied under the fair deal scheme last September, went through the rigorous application process and was approved in February of this year, when she was told she had ten days to find a nursing home.

We have all been in such situations. As a parent, I tried recently to get an appointment with a paediatrician for one of my children and was told that, whether under the public or private system, my child would not see a paediatrician until the middle of September, which I find totally unacceptable. In this case, the lady was told she had ten days to find a nursing home. When one makes the decision, one must look into it and make sure the nursing home is suitable for the person and suitable in terms of transport to visit a loved one. At the beginning of May, this lady's family finally found a nursing home which was suitable for her and for all the family. The nursing home staff came out and assessed the lady, and everybody was perfectly happy with the situation. The family went back to the HSE to be told they had gone over the ten days, had lost their place in the queue and that the process had to start again. In the meanwhile, the decision was taken not to process any more applications so this lady, like so many others, is left in limbo. This issue needs to be urgently addressed.

While there is plenty more I would like to say, I am conscious of the time constraints. I thank the Minister of State for coming to the House and wish her continued success in her ministerial role.

This is my first opportunity to welcome the Minister of State, Deputy Kathleen Lynch, to the House. I congratulate her on her appointment. If she has anything to do with reforming this issue, as Senator White and others have said, the future is certainly bright.

I am glad to have the opportunity to make certain points and I am conscious that others have greater expertise than I in the health area, including Senator Crown, and I look forward to hearing suggestions from one so knowledgeable of the health system. I can only speak as one with a business background and from personal experience, like other speakers, and I agree with much of what I have heard.

I will apply a pure business model to this case. Who projected a figure of €1 billion for the year and who is responsible when that €1 billion has run out after five months? Who is responsible for €100 million being misappropriated? Why is it taking so long for that review or examination to take place? When will we have the answers? If it was a commercial business, the answer would be instantaneous. If it was a business plan, it would be implemented the following day once it was decided. That is how these things are done.

I fundamentally disagree with the Health Act 2004 and spoke against it when I was on the other side of the House in regard to the abolition of the health boards. What was removed at that time was accountability. Now, when one writes to the HSE or to the Minister's office, although I am sure the current Minister will seek to change this, one receives a set-piece reply, "As you know, under the Health Act 2004, this is now an issue for the chief executive of the HSE and I have asked him to respond to you directly." That is what we get. At some stage down the line, when the response has been laundered through whatever public relations agency, that response may come back to the person asking the question.

This is the legacy of the centralisation of the health service through the HSE. It has slowed down and distorted the flow of information and it has not served the people well. I must qualify these comments by noting that there are many people working extremely hard and well in the HSE in caring for people in all of the various disciplines and in an administrative capacity. As a collective, however, it has not worked. The one thing I commend the new Government for is acting to change it. I welcome the Minister, Deputy Reilly's initial intentions whereby he put an interim board in place but, that said, we have not seen much progress to date. What we have seen is that €100 million has gone missing, additional moneys have been made available for this scheme to continue in the short term and there is a huge question over who originally made the projections for €1 billion to cover a year when it has only covered five months. While there is now an additional €62 million to keep the scheme going for a period, what happens when that money runs out?

Notwithstanding the good suggestions regarding care of the elderly, the demographics are changing, we have an aging population and the challenges will be much greater in coming years than at present. I agree with organisations such as the housing associations in their assessments. To take the case of the NHS in Britain, studies across the west midlands, east midlands and the east of England generally demonstrate the cost savings made while increasing the quality of care and the contentment of patients. This is significant and, notwithstanding resource challenges, we must consider these kinds of initiatives.

The questions are clear. Who controls the money? One of the first things I would like the Government to do is to take the budget back under the Department of Health's control, so the Cabinet, which is the representative of the people and the Executive charged with running the State, has control. At present, €14.3 billion, or more than 50% of the tax take for this year, is in the control of a third party organisation which is still not in a position, several weeks on from 18 May when this issue broke, to tell us where that €100 million went. This is the people's money. Some €14.3 billion is better placed in the hands of the Cabinet of the day, which has direct accountability to the people and these Houses.

The challenges are immense. I know the Minister of State will take these questions on board. I know also that if she has anything to do with it, the future is bright on this issue. Nonetheless, the misappropriation of funds is of huge concern. As Senator Gilroysaid, we probably need a weekly debate on some aspects of health in this House because there are so many important issues. I look forward to hearing those more qualified in health, such as Senator Crown and others, deliver their suggestions. From a pure business perspective, I am afraid that as a collective, notwithstanding the great work of the individuals, the HSE is a disaster.

As some of my colleagues from the previous Seanad will know, this area has been one of grave concern to me in recent years and I have become something of a long-playing record on the matter of care for the elderly. I have no difficulty with the concept of the fair deal scheme and, in so far as it can be used, I welcome it. However, the broader issue of care of the elderly in all its complexities is something we need to debate much more fully in this House. As I have said before and sadly must repeat, if our only political aspiration for the elderly is that we will be in a position to provide them with a nursing home bed when they reach an appropriate age, that is a pathetic aspiration for the men and women who built up this country.

I am interested in the figures we are debating today, in particular the missing €1 billion and the figure of €100 million. What would €100 million do? Roughly, it would provide carer's allowance or benefit for 10,000 carers. Although I admit the means test for carer's allowance has become a little more relaxed, it is still very restrictive. I sought, and made some degree of progress with the late Minister, Mr. Séamus Brennan, that the means test would be abandoned for carer's allowance and that there would be a test for a person providing full-time care and a test for a person in need of full-time care.

I ask my colleagues to reflect on how €100 million could be used today, next week or next month. It would more or less provide carer's allowance for 10,000 carers, which would be money very well spent. I said previously that we should reflect on the possibility of introducing a constitutional amendment to protect the elderly. I am an advocate of the constitutional amendment to protect the rights of children here, but the elderly also need a higher degree of protection than they have currently. If such a constitutional amendment was passed, the courts would be open on an almost 24-7 basis because our elderly do not currently receive their full entitlements.

We have gone down the road of what I call the nursing home mentality, the mentality of Shady Pines. Nursing homes have a place and a role to play, but the majority of our elderly wish to remain in their own homes and communities with their families. That should be aspiration number one. Our first aspiration should not be to provide 10,000 extra nursing home beds, but to facilitate people to remain in their communities. Will the Minister of State give serious consideration to broadening the carer's allowance and abandoning the means test? When she examines the figures, she will see they are not as draconian or shocking as she would imagine and that the provision of a carer's allowance for every full-time carer would only amount to a modest sum of money. I urge her to take this proposal on board.

The home care packages, which have worked reasonably well, were introduced by the former Minister for Health and Children, Mary Harney. Those packages can be built upon. They have played a significant role in allowing carers and people requiring care to have a degree of discretion in order that people are not simply shuttled off to permanent beds in a nursing home. The respite grants have also played a significant role in allowing families have some degree of breathing space. I welcome the attendance of the Minister of State here and appreciate that the fair deal nursing home scheme must be properly funded. It is a good scheme and while we have had difficulties with regard to its workings and the legalities, those issues are a bit of a moving feast. The current crisis, if it does nothing else but cause us to debate further our ambitions for the elderly, will be worthwhile. "Fair deal" is a nice phrase, but the fair deal the elderly really require is discretion, hope and a better aspiration than simply a nursing home bed.

I urge the Minister of State to take on the bigger picture, not just the fair deal. I am glad she has been given responsibility for the elderly and am sure she appreciates that our aspiration for the elderly must be broad. A jigsaw of solutions is required, but practical solutions such as more home care packages, greater access to a carer's allowance, more district nursing hours and more respite grants will cost only a fraction of what the fair deal costs. Those changes would transform the lives of thousands of our elderly. I hope the Minister of State considers this broad range of solutions. We must also tackle the funding crisis in the fair deal, the anomalies in the system and the anomalies with the 5% clawback.

I hope this is the beginning of an ongoing debate. Our starting point must be to remember that one size does not fit all. We need a multiplicity of solutions, but our aspiration must be to allow the majority to remain where they wish to remain, in their homes supported by their families and communities.

I remind Senators that some may not be able to contribute because, according to the Order of Business, we must allow the Minister of State to give her response not later than 1.20 p.m.

I will share my time with Senator Cullinane.

Is that agreed? Agreed.

I welcome the Minister of State. I have a major interest in health policy and hope to contribute to this debate through my membership of this House and, I hope, the health committee. I echo the calls made by some of my colleagues, and outside the House by Professor Des Fitzgerald, for a fundamental long-term strategic evaluation of how we will handle all the health and social issues which occur as a result of an ageing population. It must be remembered that in projecting forward over the years, we have often got it wrong, not because of any malfeasance or incompetence but because things change. I think of the major investment which was appropriately made at the time in fever hospitals, when we no longer have people requiring quarantine for fevers, or in large tuberculosis institutions which, thankfully, we no longer need.

There will be equally dramatic changes in the requirements for certain surgical and other procedures in the years to come as changes occur in medicine and in the delivery of health care. This will also apply to the whole question of ageing because, with current legislation in respect of retirement care, old folks homes and all the related procedures in the health system, there has been a presumption of enfeeblement. The presumption is that people in their 50s, 60s and early 70s will lose their good health and become more dependent. Obviously, this occurs as people age, but the change in our demographics and the change in our ratio of workers to pensioners is not only due to changes in the birth rate or longevity. What is happening is that we are arbitrarily taking a group of healthy people and enforcing retirement on them. There is a real need to change this.

I saw this need in the case of one of my esteemed colleagues, the professor of surgery in our institution until a few years ago. One day he was doing four or five breast cancer operations a week, perhaps being called into the hospital in the middle of the night to deal with emergency surgery and running an avid research programme, but suddenly, on his 65th birthday, he was deemed to be an old person who could no longer be an active contributor to our health system. I put this in contrast with a visit I made to the Dana-Farber Harvard Cancer Center last year where I had the great pleasure of temporarily occupying the office of a Nobel prize winner who had been the president of that institution and who had finally retired the month before. His office was made available to the Irish visitors to use as a base for making phone calls and checking e-mails etc. This man had retired from this institution, where he was still writing scientific papers, at the age of 89.

There are many people who will be enfeebled in their 40s, 50s, 60s and 70s who will need the safety net that the option for retirement, either on health or age grounds, will afford them. It is essential, however, if we are to consider how we can reconfigure pension payments for those who receive pensions and those who wish to retire versus those who wish to remain active, that, as part of the process of an older age policy, we readdress the question of mandatory retirement. I urge the Minister of State and the Leader to bring this matter to the attention of the Government because it is something that will require careful scrutiny in the years to come.

I welcome the Minister of State to the House to discuss this important issue. I agree with Senator MacSharry on the lack of accountability in the HSE. Over recent years we have all been subjected by the previous Minister for Health and Children to the best impersonation of Pontius Pilate I have ever seen in my lifetime as a politician. She took no responsibility for any of the scandals that surfaced in respect of the health service. We all know, as I know from my time as a local councillor, that when we brought something to the attention of the Minister, we were referred to the HSE or the Department. The issue was passed around and it was difficult to get any answers to questions posed. The same is true for questions raised by Deputies.

With regard to the fair deal scheme, the Minister stated recently that there was tremendous confusion between the HSE and his Department. Has that confusion been addressed and sorted out to the Minister's satisfaction? He spoke of some strange figures coming through from the various parts of the HSE. He spoke of confused messages and stated that money which belonged to one subhead had been spent on others. We are talking here about tens of millions of euro. How could this happen? That it could happen flags the lack of accountability in the HSE.

I would like to touch on two other issues. It is very important that people are cared for in their homes for as long as possible. The Minister of State will be aware, as her party is committed to this, of the need for the publication of the national strategy for carers which will deal with the needs of carers, those they care for and home helps. A national strategy for carers must be published that will deal with the needs of carers and of those in need of care. I agree with Senator Bradford who made the point that home help care needs to be built up. In my county, Waterford, many people have seen their home help hours cut. We cannot have a situation where, yet again, the vulnerable are the victims of cutbacks because of the IMF deal or the austerity measures being put in place. We have to protect the weak and vulnerable, and the elderly, which means providing more home helps, and ensuring that carers and those they look after and people in nursing homes get the very best treatment possible. That is why it is important that the fair deal scheme is properly resourced. What we need is universal provision of State care for the elderly.

We have almost reached the deadline but I shall allow Senator Kelly one minute.

I will be brief. I welcome the Minister of State, my party colleague, to the House.

In recent years I often referred to the fair deal scheme as an "unfair" deal. I agree with every statement made in the House today by all Members. We represent every sector of society and every statement should be taken on board and another look taken at how we deliver nursing home care to the elderly and deal with that group in general.

It is absolutely necessary that we evaluate the situation of elderly people who are in nursing homes to see what we can do for them and whether we should prepare to accommodate them in the community. That is where they want to be and home care packages were devised to provide that for them although funds were misappropriated within many health boards or health service areas and spent on other items. In County Roscommon most people died before their number came up, so to speak, for getting any kind of home care package money. One hour of home help per day will not entice a family to keep an elderly person at home. In County Roscommon we now talk about home help "minutes", which is absolutely laughable.

There is another unfair issue in the unfair deal. Under the old subvention system those farmers whose parents went into a nursing home did not have their farms assessed when the elderly person went into the home. Most cases in my part of the country applied to very small farmers, most of whom were in receipt of farm assistance or social welfare, or to social welfare recipients whose parents went into a nursing home without their houses being assessed. It was a big mistake to effectively privatise our public nursing homes, bringing them under the remit of what I refer to as the unfair deal.

When Age Action Ireland reports that elderly people would much prefer to be abused at home than be abused in a nursing home that is quite some choice a person has under a so-called fair deal scheme. That must be addressed.

I apologise to Senators Conway and Leyden. Unfortunately, their time is out.

I appreciate that. As the spokesperson for Fine Gael on disability and inequality, I wish to make one quick point. I have spoken in the House about the necessity to have a national debate on issues concerning elderly people. We should consider establishing a commission on the status of older people that would incorporate the 20 year strategy suggested by Senator Burke and other speakers. Perhaps the Minister of State might consider that for the future.

I thank everybody who spoke. Every contribution was extremely worthwhile, far-ranging and positive. There is one point I hear, not only in this Chamber but at any debate concerning the population of Ireland who happen to be over a certain age. People speak about these people as if they were an elusive group which is ring-fenced and protected. We have devised a positive aging strategy which will be published later this year but when we speak of planning for the future we speak of our own future. This is not an exclusive group; our future is in question. When we look at how we treat people who reach older age we should be very conscious that we are planning for ourselves. We will be very lucky to get there because many people do not reach their old age, something we should be conscious of, and examine. Those preparing the strategy on positive aging will listen very clearly to the voices of the client group we hope to serve in the future. That aspect has been missing from many debates here — listening to the people involved and asking them what they want.

When I was a member of the original health board I remember reading reports which told us very clearly that no matter what stage people are at in life they want to live in their own homes and communities. Surely we should consider having that type of support mechanism to ensure people can continue to live on in their own homes and communities with people they know and trust.

We must be extraordinarily careful in case we frighten people. When we talk about abuse one hopes there will be enough of an inspection regime in place to ensure people no longer have to fear this if they must go into institutional care. We have had a love affair with institutions in this country and those we have loved include schools, industrial homes, Magdalene laundries and care homes. There is an amazing point there. I am very conflicted on this issue for the simple reason that I now spend half my week trying to get back into the community people who have spent an enormous length of time in institutions, such as those who have mental health issues. This applies also to those with a disability. We are seriously bringing into the community people who have spent their lives living with intellectual or physical disabilities, whose homes are now in institutions. On the other hand, we seem to be in a headlong rush to put into institutions people who have reached a certain age. We really need to get our heads around that. What are we doing about it?

We have an enormous budget. I could state that €1.01 billion is set aside for institutions for people who become older because that is what we are discussing. On the other hand one could talk about €200 million odd in terms of community care for people in their later years. Look, for example, at what we are spending on disability. Let us suppose we were to combine budgets and talk about care for people who need care rather than separate out funds according to disciplines or groups, such as people with mental health issues. Why are we not talking about people who need care, whether the care in question refers to mental health issues or disability, or care for people who are older? We should combine the budgets and look at this in a sensible and practical way. The care needed in the community by somebody with a disability is not all that different from that needed by an older person in the community. It is all support and care. Perhaps sometimes it is a matter of technology, at other times of professional care, or care such as meals on wheels, home helps or provision of a carer. Think of what a personal assistant does for a person with a disability who needs such care. Is it all that different from the care needed by an elderly person? We must begin to look at this issue and start to talk about care in the community.

I am conscious that I have not addressed the points raised but will return to them. However, this conversation is very important. We need to get our heads around what the conversation must entail. We have money — we are not completely broke or penniless. We do not have additional money — and will have less — but if we do this properly we can provide better and more appropriate care in more appropriate settings for people who need it. I absolutely believe that. In mental health, for example, the bulk of our staff is found in institutions. We have least staff where they are most needed — in communities. We must switch this round entirely and perhaps we should look at it in terms of everyone else. Why do we not listen to those who need our care or who have reached a certain age? We should listen to ourselves occasionally when we ask where we would like to be. Would we prefer to be maintained at home with a little more help? None of us wants to end up in any institution among strangers, no matter how good or kind they are.

On the €100,000 missing from the subhead, it was not misappropriated. It was spent on therapies in that subhead, on people in nursing homes, although it should not have been spent on those particular therapies and drugs. All of those therapies and drugs were provided for under a different subhead. Again it comes back to how we do this and how we will care for people. Our love affair with institutions must stop.

The Government is committed to keeping older people in their own homes for as long as possible. There is, however, a process where we arrive at the point where that is no longer feasible, and we must accept that there is a place for long-stay care appropriate to needs. We must ensure quality long-term residential care is available. We must also remember less than 5% of older people are in long-term nursing home care. The vast majority are at home in their communities, where they want to be.

We speak about older people as if they were a ring-fenced group. As an ageing population, this will present challenges in the years ahead. I look forward to working with all stakeholders to bring about real change and security. If we could bottle that sense of security and give it to those who are getting older, it would cause a fundamental change in their mental health because insecurity about what will happen in their later years contributes to poor mental and physical health.

This conversation has been interesting because I do not see anyone disagreeing about where we should be going. We might disagree on how we get there but where we are going, the journey can be as interesting as the destination.

Sitting suspended at 1.35 p.m. and resumed at 2.30 p.m.