Health (Repayment Scheme) Bill 2006 - Second Stage - 7th June 2006

Health (Repayment Scheme) Bill 2006 - Second Stage - 7th June 2006
Mr. Norris: I thank Senator Quinn for allowing me to share time with him. I welcome the Minister of State to the House and welcome this legislation. I was surprised that the Minister of State’s speech contained no expression of regret because, as Senator Quinn noted, this was an illegal action on the part of the State that, in his words, amounted to theft by the State from the most vulnerable. Despite the fact that most of provisions in the Bill are purely technical, there was room in it for an expression of regret.
The Minister of State also detailed arrangements for the appointment of an outside company to administer a repayment scheme. I understand that there are possible legal reasons why information on the company appointed on 1 June cannot be made public until an interval of 14 days has elapsed, presumably to allow complaints and for the Minister of State to tell the House today the name of the company. I expect that it will be a reputable company.
I am not entirely sure if the decision to appoint an outside company is correct because other Departments have been successfully involved in the repayment of other moneys. I am aware that the amount of money in question is approximately €1 billion, which is a very significant amount, and that there may be up to 60,000 or 70,000 recipients, both living and deceased. However, in light of the fact that there are over 100 administrators in the health services receiving salaries of over €100,000 and that many of them are duplicating work, it does not seem beyond the bounds of possibility to properly employ them in administering this scheme. I do not think there is very much else for these people, or at least, those individuals who are duplicating work, to do.
The Minister of State also referred to a consultation process and listed the various people, including the Ombudsman, with which he, very appropriately, has consulted. The Ombudsman has, obviously, been very unhappy with the situation for a considerable period of time. I also noted that Age Concern is not among the non-governmental organisations consulted. Would the Minister of State consider including this very valuable group in this process?
Yesterday, the Office of the Ombudsman published on its website a reprint of an article that appeared under the name of Emily O’Reilly - the Ombudsman - in The Irish Times on 5 July 2005. The title of the article was “A system that leaves the door open to injustices”. In the article, the Ombudsman listed three specific cases. According to the article:
Several factors are common to all three. The mothers were placed in nursing homes only when they had become so ill that not even assisted home care could meet their needs. All three have medical cards and were therefore entitled to public care. In each case, no public bed was available and all three were effectively forced into private care, with fees of up to €3,500 per month.
These were caring families whose mothers possessed medical cards and were, therefore, entitled to public care. No public beds were available to them and they were forced to go into private care. The article then goes on to state:
In all three cases, the value of the mother’s residence has been taken into account by the health authorities as it assessed the level of State subvention to be provided, a relatively small fraction of the cost in most cases, but of critical importance to families struggling to pay the huge private fees.
The Ombudsman described how in one case, the mother’s house remained the only home of her single middle-aged son. This is a very human situation yet the house was taken into calculation. She wrote that if the house was sold to help defray the nursing costs, he would be forced into the private rental sector. This is not a socially constructive approach. According to the article:
In another case, the mother part owns the home with her son. It has been suggested that he might “buy out” the mother’s share in order to increase the subvention, but this could bring his borrowings to an unmanageable level.
This, again, represents a very severe squeeze of an innocent individual
third case involved a relatively recent transfer of the ownership of the family home, which allowed the authorities to assess its value. This was a mean-minded way to approach the situation.
Subsequently, the Ombudsman investigated the subject and indicated that the reason was the unusually large and steady flow of complaints. More than 150 had been received since the commencement of the scheme in September 1993. She made the serious point that the complaints received since then “reflect not just the actions of individual offices or public bodies; rather they reflect the corporate response of virtually an entire sector”. We are not talking about mavericks or an unrepresentative situation. Instead, there has been a concerted approach.
Under the Act of 1970, every citizen has the right to avail of legislation——
An Leas-Chathaoirleach: As it is now 5 p.m., will Senator Norris move the adjournment of the debate?
Mr. Norris: I will finish my point. These measures were taken due to financial constraints. The Ombudsman states that the Department was well aware of the situation and lists a series of doubtful practices, including the use of regulation without recourse to the Oireachtas. The Minister of State will be aware of these criticisms and the doubtful practices, which are serious. The attitude of the Department and the unreasonable promulgation of discussions with the Ombudsman are a reproach to us all.

I welcome the Minister of State back to the House, refreshed after our short break. In 1990 the Health (Nursing Home) Act was passed by the Oireachtas, coming into force in September 1993. This was intended and proclaimed to be a radical improvement on the old system. The Ombudsman’s report contradicts this, however, claiming that the Department and the health boards operated the new system in a way that was against the interests of patients and deprived them of their own money, a serious charge. She also stated that the Department was perfectly aware that its approach was legally unsound. This puts into context the remark on the other side of the House before the break that this was the best kept secret in the Civil Service. It is difficult to believe the political masters of the Civil Service were unaware of the situation, which was so widely flagged and so clear to the Ombudsman.
The doubtful practices listed include the making of regulations containing provisions which are likely to have been against the law, including at least one instance in which the likely invalidity probably had been known in advance. That goes back to the matter I have just raised. Also mentioned is the inclusion in a regulation of a provision which, it appears, was intended from the outset would not be applied. That sounds like sharp practice. A further doubtful practice was the unreasonable prolongation of discussions with the Ombudsman about practices which it appears were known from the outset to be invalid or incorrect. That is unjustifiable prevarication and it is totally disingenuous.
Finally, there was the failure of some health boards to alter practice, even where the legal advice was that the practice was incorrect and where the Ombudsman had expressed the same opinion. The health boards were advised legally this was inappropriate and the Ombudsman was expressing concern but the practice persists. No defence of ignorance could be entered.
The Ombudsman’s experience of complaints between 1993 and 1999 suggests that the underlying problems of complainants which surfaced prior to September 1993 continued to manifest themselves under this new regime. There were plenty of problems and they were flagged. A serious situation has arisen recently with regard to the law on statutory rape and at its heart was the question of communication deficits, to put it politely. It seems this also happened here in the Department. That is regrettable and I hope the Bill goes some way towards mending the situation.
The Bill contains a provision for the recipients of this money to render it back to the State if they do not need it so it can be used by the health service. That may be an honourable thing to do but I hope that no moral pressure will be put on people to do so. I salute those I heard on the radio saying they were grateful to the health services for the way in which their relatives were treated. They also said they would not wish to take this money.
As I understand it, there is no systematic inspection of public nursing homes for the elderly. If that is the case, such a system should be instituted. While this is not directly germane to the matter, people should be made aware that the development of bedsores among patients in these institutions is absolutely unnecessary and indicates bad nursing practice. Relatives often believe that bedsores are the inevitable consequence of the aged being bedridden but they are not. The matter is a cause for concern and there should be regular inspections of nursing homes.