Business of Seanad.
Order of Business.
Report on Long-Stay Care Charges: Motion.
Health (Amendment) Bill 2005: Second Stage.
Child Care Services: Motion.
Health (Amendment) Bill 2005: Second Stage (Resumed).
Chuaigh an Cathaoirleach i gceannas ar2.30 p.m.
An Cathaoirleach: I have received notice from Senator Bannon that, on the motion for the Adjournment of the House today, he proposes to raise the following matter:
I have also received notice from Senator Cummins of the following matter:
I regard the matters raised by the Senators as suitable for discussion on the Adjournment and they will be taken at the conclusion of business.
Ms O’Rourke: The Order of Business is No. a1, a motion the subject matter of which is to be referred to the Oireachtas Joint Committee on Health and Children for consideration, to be taken without debate. We are endeavouring to have a debate on this issue tomorrow. We have been in touch with the Tánaiste and Minister for Health and Children’s office. The Tánaiste is before the committee currently and, therefore, a time for the debate cannot be specified. However, we expect the debate on the report to be taken tomorrow.
Mr. O’Toole: Is that the Travers report?
Ms O’Rourke: Yes, tomorrow.
Mr. O’Toole: On a point of order, normally a referral motion is taken without debate on the basis that the subject matter will not be discussed in the House. Is the Leader saying it will be discussed in the House as well as being referred to the committee?
Ms O’Rourke: The matter will be discussed in the Dáil tomorrow between 1.30 p.m. and 3.30 p.m. and we are seeking time tomorrow for a similar debate on the report. No. a1 is a procedural matter that must be agreed. The joint committee is meeting currently and, because the Tánaiste is attending the meeting, an exact time for the debate could not be ascertained. We will be informed later in this regard. We sought a debate first thing this morning and we will have it. It is a matter of arranging a time.
No. 1 is the Health (Amendment) Bill 2005 — Second Stage, to be taken at the conclusion on the Order of Business until 5 p.m., to resume at the conclusion of Private Members’ business and conclude not later than 8.30 p.m., with the contributions of spokespersons not to exceed 15 minutes, those of other Senators not to exceed ten minutes and the Minister to be called on to reply not later than ten minutes before the conclusion of Second Stage; and No. 19, motion 14, will be taken between 5 p.m. and 7 p.m.
Mr. Finucane: I had intended to move an amendment to the Order of Business but I will not do so on the basis of the reassurances given by the Leader that the Travers report will be discussed tomorrow. Most of us have only had sight of the report over the past hour. It is an interesting report but I would like to study it in greater detail. One pertinent issue emerging from the report is the serious criticism of the Department of Health and Children, particularly at senior level. We will closely follow what happens in this regard. Another serious issue concerns the responsibilities of Ministers and Ministers of State and, in particular, special advisers, of whom there are many. They usually act as a conduit between Ministers and the Department. Special advisers are criticised in the report regarding whether they could have informed Ministers in greater detail about what was happening.
According to the account of the famous December 2003 meeting attended by three Ministers, all briefing documents were sent to them in advance and, therefore, it is remarkable and surprising that they should deny knowledge of the content of the meeting or that people left the meeting. However, we will debate this tomorrow and I will be interested in the Tánaiste’s comments.
Anybody who read today’s Irish Examiner could not have been but appalled by the arrogance of P. O’Neill and the IRA’s statement, which is published on the front page. The IRA has sunk to an all-time low in the context of Northern Ireland issues by approaching the McCartney family and threatening to assassinate its own members and other individuals to resolve the current problems. They were going to set themselves up as judge, jury and executioner in the process. I wonder where we have been over the past two years in discussing the Good Friday Agreement, the implementation of which has gone on since 1998, to have such a statement emerge in early 2005. It is time people got real regarding the backdrop and undercurrent of republicanism masquerading as mafia activity. We cannot countenance that situation continuing and serious questions must be asked of the Sinn Féin leadership. Ultimately, people rely on them regarding the IRA. Let us get this peace process back on track.
I respect the fact that we have insisted on an end to criminality. If we wanted reassurance of its necessity, we see it in the context of this statement, which I read with horror and contempt. Any true person in the State would have to deplore the fact that anyone could make such a statement and hail himself or herself as a republican. The McCartney family have confronted the IRA and Sinn Féin in their natural territory up there, winning respect for the fact that, since the case emerged, much has come out regarding what goes on in the North of Ireland that we would not otherwise have known.
Mr. O’Toole: I made the point yesterday on the Order of Business that I felt the current arrangements in primary schools whereby untrained personnel have responsibility for the so-called “teaching” of children is another pot waiting to boil over on the Government. It could certainly lead to a class action on the part of parents seeking to question the Government ignoring the constitutional imperative requiring it to provide for free primary education. That must imply professional standards, something mentioned later in the Constitution. I say this because, if it takes me 17 years to convince the Government to do so, at least my concern will have been recorded time and time again. I respectfully ask the Leader to bring this formally to the attention of the Attorney General to reassure ourselves that this problem does not need a solution at this stage.
The Travers report that we will be discussing is also very topical today, since the person who seems to be accepting responsibility for long-term and systemic corporate failure, the Secretary General of the Department, is apparently leaving it. That is perfectly understandable; we have seen such situations in several places in recent years. However, it would be the height of cynicism, utterly unacceptable and impossible to explain in a democracy if that person were rewarded with some similar or promoted position anywhere else. I feel sadness for the person concerned, since I am sure he is very hard-working, but this matter needs closure and his entitlements should not be augmented. Leaving the Department should not be the gateway to some other similar or promoted position in the public service. I do not say that in any personal manner, but I would like to have it on the record.
I absolutely agree with Senator Finucane that the outrage that has greeted the Provisional IRA statement is perfectly understandable. However, I would also like to sound a note of caution. Whereas we are all of one mind in the Irish political landscape, North and South, in pubs and other places around Ireland, many people will say that shooting or getting rid of the perpetrators is the right way to deal with them. We have a great deal of education to carry out to explain to people that this is utterly unacceptable for reasons that affect every citizen of the State.
Mr. Norris: Hear, hear.
Mr. O’Toole: It is crucially important to record the further comment of the McCartney family today that they sought justice rather than revenge. That is so articulately expressed that it puts in context the importance of justice in a democracy.
Mr. Ryan: I appreciate that there is to be a debate tomorrow regarding the Department of Health and Children. However, can the Leader ask whoever is responsible — I am not sure if it is the Taoiseach — to ensure that every Department now checks that there are no files floating around advising it that current practices are unconstitutional or otherwise illegal? We can debate the specific issue tomorrow but the fundamental issue is about the quality of governance in the country and there has been a monumental failure to meet that quality. On the issue of political accountability, Mr. Travers, true to form of Ministers, could not find any evidence that conclusively proved anything. There is a series of pointers but we can talk about that tomorrow.
Some Members may be aware that last week, on what describes itself as a popular radio programme, although I am not sure many people listen to it——
Ms O’Rourke: Vincent Browne.
Mr. Dardis: That is not a popular radio programme.
Mr. Ryan: That is why I said what I said.
An Cathaoirleach: We cannot discuss the radio programme, whether popular or not. Senator Ryan, we cannot identify the programme to be fair.
Mr. Ryan: I said something similar to what Senator Finucane has just said and the presenter of the programme said that was pomposity and a rant. I want to record that if it is pomposity to make it clear that killing other people is murder, that justification of the killing of other people is appallingly wrong and that sitting in a radio studio and allowing people to justify the murdering of other people is wrong, then I am pompous.
Senators: Hear, hear.
Mr. Ryan: If to make a strong and passionate speech about it is to rant, then I am quite happy to rant. We saw yesterday what I was talking about last Thursday night — people who have no morality, no politics, no understanding of justice or law and who have revealed themselves to be precisely what they are, namely, murderous thugs. Whether they are elected to Dáil Éireann or not, when they are killing people they are murderous thugs. They are not republicans and they serve no purpose other than to hold back progressive politics and republican politics in this State. The newspapers made it clear yesterday. We now know well what we all tried to avoid looking at for the past ten years, namely, that we have murderous thugs in our midst who must, once and for all, stop what they are doing, go away and retire and let those of us who believe in democracy get on with the job of democracy.
Mr. Dardis: The House and the island as a whole, whether North or South, owes the McCartney family a considerable debt of gratitude because it would have been very easy for them to assent to the obscenity of the IRA’s statement. One can readily appreciate the pressure they would come under within their own community. It is remarkable that they have resisted that pressure from beginning to end and for that reason they are to be applauded.
It is amazing that the IRA should decide that people should be shot for alleged crimes. We have to proclaim in these Houses the rule of law, both north and south of the Border. To think that the IRA might take out people unilaterally and shoot them is beyond belief but we should not be surprised about that. The surprise is that we are surprised because for 30 years they shot and bombed innocent people in the name of republicanism. That is not the republicanism with which any of the republicans in this House have anything in common, and we do proclaim ourselves to be republican in the best sense of the word. It is important that we speak about these matters. Senator O’Toole is correct. There are people in certain sections of this society who believe it is appropriate treatment for people who deal in drugs to take them out and shoot them in the knees. We have to say that is not appropriate treatment. What those people do is wrong but that is not the penalty they should pay.
With regard to the Travers report, we will deal with it in more detail later and I thank the Leader for the efforts she is making with respect to having statements on it because we need to consider it more carefully. We have not had time to go through the report in any detail but it is quite explicit and reaches firm conclusions. It contains 11 recommendations which must be taken on board. The report refers to long-term, systemic corporate failure within the Department so there are matters of administration and politics that need to be dealt with.
I agree with Senator O’Toole on the matter of people being accountable. People with grave responsibility, whether this be political or administrative in nature, must be held accountable. In the event that failures occur, accountability must apply. We will have an opportunity to discuss these matters in greater detail when the Travers report comes before the House.
Mr. Coghlan: I welcome the information the Leader gave to the House in respect of the debate on the Travers report being arranged for tomorrow. The report indicates that the Tánaiste was correct about the maladministration which existed in the Department for which she recently assumed responsibility. It also highlights the long-term, systemic corporate failure in that Department. In addition, it records that illegal practices took place and that the Secretary General, despite it having been agreed that he do so, failed to advise the Attorney General. Will the Leader, as the conduit between the House and the Government, provide an assurance in advance of tomorrow’s welcome debate that none of the practices and procedures to which the report refers — which were so wrong and, in some instances, illegal — are in any way prevalent in other Departments?
Mr. Mooney: In a week when the focus will be on Ireland and when Government representatives and colleagues from both Houses will be travelling to destinations across the globe, does the Leader agree that it would be opportune to have a debate on emigrant issues following the recess? It would be particularly apt to hold such a debate in light of the significant increase in funding the Government has provided in recent weeks which has been disbursed by DION to Irish organisations in the UK. The Leader is, like other Senators and me, a member of the Joint Committee on Foreign Affairs and she will be aware that a delegation from that committee recently visited London and Birmingham to witness, at first hand, the issues with which Irish people there are faced. We may be enjoying the fruits of the Celtic tiger economy but there are matters relating to the Irish diaspora which remain to be dealt with.
It is a credit to the former Minister for Foreign Affairs, Deputy Cowen, who implemented much of the task force report on emigration, which was debated in the House——
Mr. Ryan: The Minster did not provide the money.
Mr. Mooney: He did provide it.
Mr. Ryan: He did not.
Mr. Mooney: There has been a significant increase in the amount of that money, which is now of the order of €9 million.
Mr. Ryan: He did not provide the amount that was recommended.
An Cathaoirleach: Senator Mooney, without interruption.
Mr. Mooney: If Senator Ryan was in contact with the Irish community in Britain to the same degree as I am, he would be aware that it has welcomed this increase and embraced it enthusiastically.
Mr. Ryan: That community would hardly reject an increase.
Mr. Mooney: It has also publicly acknowledged the contribution the Government is making towards the issues facing emigrants in Britain. The point made by Senator Ryan is low in nature and he should read up on what is happening in the UK.
Will the Leader consider arranging a debate on this matter? It is important that this House, which is a forum for debates of this nature, should continue to highlight emigrant issues in order to ensure that those to whom we refer as the “forgotten people” will not be forgotten.
Mr. Norris: I agree with colleagues who raised the subject of the IRA statement. That organisation could not possibly have given a clearer or more convincing illustration of its own innate criminality than it did in the statement. It was approached about one murder which was so brutal, vicious and cruel that people within its community compared it to the operations of the Shankill butchers some years ago and it responded by proposing three further murders. That is an astonishing approach. It is time people realised that, despite the kewpie doll appearance and DART accents of some of that party’s recent candidates, a vote for Sinn Féin is a vote for kidnap, robbery, rape and murder. It is not appropriate that people in recent vox pops in the two by-election campaigns should state that Sinn Féin might be better able than other parties to obtain for them their council house, a television set or whatever. Such an approach should not be taken when dealing with hardened criminals and murderers.
I honour the McCartney sisters who, as other Members pointed out, have asked for one thing, namely, due process. That is the basic level at which everybody should operate. Something similar to what happened to Robert McCartney happened seven years ago to a Mr. Kearney, whose mother appealed for information about his killers. She received an apology from some of the Sinn Féin leaders, but nothing more was done about it. I will not recite all the murders carried out, but it is time to shout “Stop”.
I am astonished to hear our national broadcasting station and see our newspapers refer without question to the 100th anniversary conference of Sinn Féin. If we accept that, we are saying that all the political ancestors of the parties in this House were the same as these people. That is a worrying thought.
Dr. Mansergh: I was absolutely taken aback by last night’s IRA statement, which can only be described as surreal. Sinn Féin and the IRA were also linked 80 years ago in the same way they are now. The republican political leadership met in August 1924 and Deputy Seán McEntee said that although Sinn Féin claimed to be the de jure Government, he could not stand over the army, meaning the IRA, exercising powers of life and death unless it was in Government with the full mandate of the people. In response, Eamon de Valera said that that was absolutely his position as well. He believed the IRA could not have power of life and death over people, nor could it even have power over property in a situation where there was peace. If we had the same moral clarity from the republican political leadership today that came from Eamon de Valera and Seán McEntee in 1924, then we would be a great deal further forward.
Senators: Hear, hear.
Mr. McHugh: A health and safety audit has been carried out on a national basis in most general hospitals over the past two weeks. The main objective of this audit is to determine whether hospitals are in breach of health and safety guidelines. Can the Leader ask the Tánaiste on what basis these hospitals were selected? Why was Letterkenney General Hospital not selected? I have a sneaky suspicion that, as a result of overcrowding in the accident and emergency unit in the hospital, one Department would hold another Department in breach of the health and safety guidelines.
We are sometimes very critical of RTE on its programming of cultural events. There was a very good programme on RTE last Sunday on the culture of south Donegal fiddle playing and its connection with Scotland. However, it was broadcast at 9.30 a.m. RTE needs to get real with the timing of its programming. That would be a good programme for evening viewing.
Mr. Dardis: It must have been a religious experience.
Dr. M. Hayes: I am tempted to say to Senator McHugh that an even better programme could be made about fiddling in south Armagh.
Dr. M. Hayes: I want to express horror at the statement made by the IRA. These are people who have beaten a path to the European courts and have sought sworn inquiries on everything. They are also prepared to murder people without any sort of due process. It does point to the precedent which Senator Mansergh has so accurately drawn. That point of decision has come for today’s Sinn Féin and their leaders should take it.
Can the Leader ask the Minister for Health and Children what steps are being taken to assess the risk in hospitals for the hospital bug? There has been strong activity on that in the North and I wonder whether it has been replicated here. I did not have time yesterday to raise the issue of children being taken into care. I do not wish to go into the details of a particular case. However, looking at the matter from a health economist’s viewpoint, it would cost approximately €2,000 per week to put four children into care. It will make matters worse if they are split up. If, on the other hand, that family was given €2,000 per week it would sort out many of their problems.
Mr. Bannon: Yesterday’s IRA statement has sent shock waves through the entire community, as other Members have already said. The IRA’s claim to be involved in the peace process appears to be very negative following the most recent statement. Murder is murder, yet the IRA’s answer to crime in Northern Ireland is to commit more murder. The IRA’s claim to have offered to kill the three people who were involved in the murder of Robert McCartney is shameful and disgusting. It has sickened the community. It is not that long ago since a former colleague of ours, Senator Billy Fox, was murdered. It is time to tighten up security in this State. It is necessary to do so and it will have to happen soon, rather than dealing with those criminals.
I ask the Leader to invite the Minister for the Environment, Heritage and Local Government to attend the House for a debate on housing. What does the Minister, Deputy Roche, plan to do to eliminate poor quality housing in many rural and urban areas?
We should also discuss the threat to the disabled person’s grant scheme. A number of local authorities are considering the introduction of a means test for that scheme. That is a dreadful proposal because it will hit the most vulnerable in our society. The disabled person’s grant and other schemes for the elderly and disabled should not be subject to means tests.
Mr. Quinn: We have been stunned by yesterday’s announcement from P. O’Neill. Today’s reaction is a reminder of how we must value our democracy, although we do not do so nearly enough. We must do so, however, having heard those words and the threats that were made in the IRA statement. Given that we have not always valued our democracy enough, we should remember what occurred today in Egypt where the Government prevented a new newspaper from being published because it supported an opposition candidate. Those of us who criticised and condemned the war in Iraq should recognise that some signs of democracy are beginning to appear in the Middle East. We value our democracy, so we should encourage those signs of democracy elsewhere, be they in Palestine, Libya, Lebanon, Egypt or Afghanistan.
An Cathaoirleach: Five Senators are offering but only four minutes remain for the Order of Business, in accordance with Standing Orders. I ask Senators to be brief. I will not be able to take any further contributions.
Mr. Bradford: I agree with the call from Senator Mooney for a debate on emigration. Last week, it was mentioned that there is a strong possibility of progress being made on the visa situation facing illegal Irish immigrants in the United States. The Oireachtas should be seen to be proactive in that regard.
I agree with everything that has been said by my colleagues on the Northern Ireland question. The IRA statement is shocking, chilling and totally out of touch with the vast majority of people, North and South. The Leader should arrange for a substantive debate on Northern Ireland at an early date. Over the years, a degree of caution has been exercised in such debates due to fears that people may say the wrong things. Sometimes, however, as a result of our silence on matters north of the Border, including the issues facing the Nationalist community there, we allowed a vacuum to be created which was filled by the wilder men and women. The constitutional parties in this House, Fianna Fáil, Fine Gael, the Labour Party and the Progressive Democrats are republican and Nationalist but above all they have a sense of justice and responsibility. We must reclaim the debate and ensure that every citizen of Northern Ireland, whether loyalist, Unionist, Nationalist, Catholic or dissenter, knows that he or she will be properly looked after by the democratic politics of the democratic parties on this island. We must take responsibility and not allow the wild men of Sinn Féin to be in charge of policy in the Northern debate.
Mr. Ross: I do not know why we cannot try these people for war crimes. Perhaps the Leader can shed some light on this issue. They claim to be fighting a war, have indulged themselves in ethnic cleansing, are taking on the State and are taking the law into their hands to murder people at will. They also look for prisoner of war status and it seems there is a good case for referring such people to the same sort of justice applied to others.
I wholeheartedly agree with Senator Ryan’s point. If people are given a fairly free, although not unchallenged, run to talk about their attempts at murdering people in the national media and others are interrupted and mocked for denouncing this sort of violence, our society has reached a stage of corruption of which we are not aware. There is a real danger that we are beginning to accept the ethos and language of violence. The IRA cleverly demonstrated this last night when it shocked us into realising that we are now beginning to accept the language of murder without batting an eyelid. This is a salutary lesson for all of us in this House, one about which we are united. There is a creeping language of murder and violence which is not acceptable. If Senator Ryan is to be challenged while others are not, we should look again not only at the behaviour of the media but of the national broadcasting station.
An Cathaoirleach: The Senator has made his point adequately.
Mr. J. Phelan: I agree wholeheartedly with the comments made by Senator Ross and others who have referred to yesterday’s IRA statement.
I thank the Leader for her efforts to try to ensure we have a debate on the Travers report tomorrow. We have seen the first casualty today but the contents of the report are very revealing. If there is to be any fairness, there must be political casualties in regard to what has happened as well as departmental casualties.
In advance of the discussion of financial matters in this House in the next few weeks, I wish to raise the issue of rollover relief which was abolished by the Government in a budget two or three years ago. This is particularly relevant in the context of the roads which we all know need to be built throughout the country under the national development plan. This relief would have provided some solace for the landowners affected and, in that context, I urge the Department of Finance to review the decision it took on this issue two years ago.
Mr. Feighan: I was also shocked by last night’s IRA statement in which it stated that it had offered to kill the killers of Robert McCartney. People’s reaction was to ask from where the statement was coming. Despite various statements and hot air and the McCartney family’s visit to Dublin, the IRA has still failed to produce a single witness statement from any of the people involved. We should focus on this issue because we want and expect due process.
Will the Leader ask the Minister for Arts, Sport and Tourism to address why the national conference centre proposed for Dublin for the past ten years is still in a stalemate situation? We will lose over €1 billion worth of tourism and conference business from all over the world for as long as this is delayed. The Minister for Arts, Sport and Tourism has reneged on two dates since January. Will he decide a date on which the international conference centre will be proposed? I ask him to make a speedy decision.
Ms Terry: I support the comments of Senator Maurice Hayes in regard to the cost of taking children into care instead of spending that money on providing relief to the family at home. This is in light of recent events which we do not want to examine. It is time for a debate in the House on the issue of children at risk because it has been brought to my notice, not just because of recent events, that many children are at risk in their homes.
The relevant services are unable to cope with the level of work that is required due to the lack of resources. One must be surprised at the speed with which the services moved this week when, at the same time, we know children are at risk and neglected in Dublin city and throughout the country. It would be opportune if the Minister would come to the House to outline the level of service available and, more importantly, to highlight the number of children at risk who are not being catered for.
Ms O’Rourke: Senator Finucane, the acting leader of the Opposition, referred to the Travers report but stated he would wait until tomorrow to comment definitely on it. He also referred to the IRA statement from the infamous P. O’Neill. The Senator set the tone for the mini-debate we have had. The statement was breathtaking in its chilling obscenity. One could hardly believe what one was reading or that the wording was correct. The McCartney family has brought home to us this stark realisation.
Senator O’Toole again raised the issue of untrained teachers after stating yesterday that a class action on the matter by parents was possible. The Senator asked me to bring the issue to the attention of the Attorney General. I will bring it to the attention of whoever is the proper legal authority. The Senator also requested that while he understood the entitlements of a particular person leaving the Department of Health and Children, there would be no reward for him in another position.
Senator O’Toole also raised a point that was brought home strongly to me. He stated that pub talk would lead some to say: “Is that not what they deserve? They deserve to be shot.” The Senator is correct that this kind of comment can be easily said and assimilated. However, in this case, it is a bad example.
I felt proud last week that Senator Ryan was a Member of the House and that I shared membership with him. I heard almost the whole debate to which he referred, although not the final part when the Senator was cut off. However, Senator Dardis has affirmed that part to me. I heard most of the debate because I try to be in my car when there is something on the radio I can listen to. The Senator did us all proud. A newspaper reprinted the text of the debate at the weekend. Was it The Sunday Tribune?
Mr. Norris: It was The Irish Times.
Ms O’Meara: It was the Sunday Independent.
Ms O’Rourke: It was one of the weekend newspapers. It was something else to try to hold one’s own in that atmosphere. I was amazed that somebody would seek to direct the tone of the debate in that way. Well done to the Senator.
Senator Ryan referred to the quality of governance and stated that killing other people is murder, which it is, and that the killers are not republicans but murderous thugs. Senator Dardis rightly said we all owe a debt of gratitude to the McCartney family. He said that we should more often proclaim ourselves republicans in the best sense of the word, with which all of us in this House would agree. The Senator then spoke of the Travers report and the corporate failure. Hopefully we will have a chance to deal with that tomorrow.
Senator Coghlan asked if I can confirm whether the departmental maladministration is replicated elsewhere. I cannot do so as I have neither the right nor the information.
Mr. Coghlan: I referred to practices and procedures.
Ms O’Rourke: I am not in charge of those issues in the various Departments.
An Cathaoirleach: I thought that was an unfair request by Senator Coghlan but I did not intervene.
Ms O’Rourke: I thank the Cathaoirleach. As I read it, the Travers report made recommendations which if implemented would mean that maladministration would not be repeated. Senator Mooney called for a debate on emigrants and asked if that would be suitable when we return after the recess. Senator Norris said there was clear evidence of IRA criminality. If there was any doubt about that, the IRA laid it out, which was interesting. Due process is what the McCartney family is seeking. Senator Norris questioned, as we all do, the “100th anniversary” celebrated by Sinn Féin. What Senator Mansergh said was good. Former Deputy Seán McEntee and Eamon de Valera outlined with great clarity what they would not stand over. We need that same moral clarity now.
Senator McHugh asked why particular hospitals were singled out for the health and safety review. I do not know, but we can raise the matter with the Department of Health and Children. He also mentioned the excellent RTE programme broadcast at 9.30 a.m. about fiddle playing in Donegal. Senator Maurice Hayes noted the murderous IRA statement. He also asked in which hospitals the MRSA bug was prevalent. He referred to the huge cost of taking children into care, an issue discussed in this House yesterday. There may be more to that particular case than we know.
Senator Bannon rightly said that the IRA statement sent shock waves through the community and that we need to tighten up security in this State. He also called for a debate on housing and for clarity on the disabled person’s grant. I did not hear that the grant might be means tested. I dealt with two applications last week and that issue did not arise.
Mr. Bannon: In certain counties, Kildare for example, where a by-election is taking place, the grants are means tested.
Mr. Dardis: The Senator should not believe everything he hears on the doorsteps.
An Cathaoirleach: The Leader to reply without interruption, please.
Ms O’Rourke: It would be rather silly to introduce a means test in the course of a by-election.
Senator Quinn said we do not treasure or talk up enough the democracy we all share. He noted that in Egypt, where the opposition candidate is daring to challenge the leader, who has ruled for so long, a newspaper which would have supported the opposition candidate was suppressed. Thankfully that is the sort of situation we know little of in this country.
Senator Bradford explained to me that he had to leave the Chamber but asked for a debate on visas. He said that during all the debates we have had in this House regarding Northern Ireland we have been tiptoeing around matters because we do not want to upset anyone who might be taking a forward step or upset what might be happening. Perhaps we should now stop tiptoeing and describe things as they are.
Senator Ross said that certain IRA members should be tried for war crimes as they have been involved in so-called ethnic cleansing, have taken on the State and have taken the law into their own hands. Senator Ross then referred to the truncated radio debate in which Senator Ryan was involved.
Senator Phelan noted that the Travers report is very revealing and asked for a review of rollover relief. Senator Feighan referred to the IRA and due process. He spoke of the conference centre mooted on many occasions and asked for a statement on it by the Minister for Arts, Sport and Tourism.
Senator Terry noted the cost of taking children into care and said that many children are at risk in their own homes. I have no doubt that they are. It is a broad debate and perhaps we might ask the Minister for Health and Children to attend the House to discuss the matter.
Order of Business agreed to.
Ms O’Rourke: I move:
Question put and agreed to.
Question proposed: “That the Bill be now read a Second Time.”
Minister of State at the Department of Health and Children (Mr. S. Power): I am pleased, on behalf of the Tánaiste and Minister for Health and Children, to introduce Second Stage of the Health (Amendment) Bill 2005 to the House. This Bill provides for the amendment of the Health Act 1970 to address two substantive matters, namely, to provide a legal framework for the charging of patients for the maintenance element of inpatient services in publicly funded long-term care residential units and for the introduction of doctor-visit medical cards.
All Governments and all parties in Government have supported and implemented the policy of requiring some contribution towards shelter and maintenance of people with full eligibility in long-term stay institutions. The Supreme Court recently confirmed that it is constitutionally sound for the Oireachtas to legislate for this policy. The issue is finally being put beyond legal doubt after nearly 29 years.
The Bill will also provide for the introduction of a doctor-visit medical card as announced at the publication of the 2005 Estimates. This fulfils a key commitment of the Government to ensure that people on low incomes should have access to GP services and advice. It is most efficient to address both issues in the same Bill.
There is close to all-party consensus that it is reasonable that people in public long-term stay places should make some contribution, where possible, to living costs, or “shelter and maintenance”. The consensus on the issue is clear, given that the policy was implemented by successive Governments and Ministers for Health, albeit on a legally flawed basis, for at least 29 years. It is also clear from public debate and debates in this House over the past three months, that most people accept it is fair to require a reasonable amount to be contributed, particularly considering that older people living at home must meet their living expenses from their pensions.
On foot of advice sought by the Tánaiste from the Office of the Attorney General, the Department of Health and Children issued a letter on 9 December 2004 to the chief executive officers of the health boards and the Eastern Regional Health Authority asking them to immediately stop making such charges, pending the introduction of amending legislation.
Accordingly, a statutory framework that puts the long-standing policy on a sound and statutory legal footing and safeguards the income generated from this source is vital. Let us remember that this income is spent exclusively on health services and does not revert to the general Exchequer. It is part and parcel of health funding and has been for decades.
The constitutionality of legislating for these charges in the future was fully tested in the Supreme Court and was found by the court to be constitutional. For example, the court stated:
The court also pointed out:
It was useful that the court recognised the importance of this source of funding for health services, in the order now of €2 million to €2.5 million per week.
The clarity provided by the Supreme Court has paved the way for the introduction of the Health (Amendment) Bill 2005, which provides the legal basis for charging for inpatient services in publicly funded long-stay institutions.
Quality care is expensive and the bulk of the cost of providing a high standard of quality care should be borne by the Exchequer. It is estimated that the charges imposed on those in public nursing homes represent approximately 10% of the overall cost of care. This represents a modest, though very important, contribution towards the total cost of treatment and maintenance.
The charges in question are embraced by the concept of what is in effect a co-payment, which is common throughout the health service. This is consistent with the overall principle that where individuals are in a position to contribute a modest amount to the cost of their care, it is reasonable that they do so. Other examples include the inpatient overnight hospital levy. In the latter case, the charge is currently at the rate of €55 per night subject to a maximum of €550 in any 12 consecutive months. Those availing of private or semi-private accommodation in public hospitals are also charged.
What we are concerned with today, therefore, is the implementation of policy for the future. In debating this Bill now, we should focus on its provisions and look forward to the clarity and benefits they will bring rather than debating how the issue of charges has been dealt with over a period of many years. I am conscious of the fact that the Travers report has been published today and I am sure the House will have ample opportunity to discuss the report in the future. The Government’s policy on the development and delivery of services for older people is to maintain these people in dignity and independence at home for as long as possible in accordance with their wishes, to restore to independence at home those older people who become ill or dependent and to encourage and support the care of older people in their own community by family, neighbours and voluntary bodies. All the studies we have undertaken show that people are far happier in their own homes and want to remain there as long as possible. It is important that we make every effort to ensure that those wishes are granted.
It is obvious, therefore, that the roles of all community care services are vital to the implementation of this policy. The charges which can be raised under the provisions proposed in this Bill will assist in providing funds to help in the implementation of these overall policy objectives in the future. I am very pleased also to propose to the House those sections of the Bill providing for new medical cards to make GP services free for many thousands of people.
On 18 November 2004, in conjunction with the publication of the 2005 Estimates, the Tánaiste announced the Government’s intention to introduce a doctor-only medical card for some 200,000 people. This was the most efficient way to help most people to access primary care and is in line with the commitment contained in the health strategy to ensure that the allocation of medical cards is on the basis of prioritising groups most in need.
This is one of a package of developments we have announced regarding the medical card scheme. The others involve adjustments to the income guidelines in respect of standard medical cards which will enable some 30,000 additional people to obtain a standard medical card in the current year.
These new income guidelines have been in force since January 2005. They reflect a 7.5% increase on the 2004 figures, as announced in November 2004, and also include substantial increases in respect of dependent children. Parents of children with very serious illnesses that persist from year to year can also be assured they will not have to reapply for a medical card each year, thus alleviating the anxiety of wondering if their medical card will continue. The introduction of doctor-visit medical cards is an innovation for social justice and for the effective use of public resources.
For many years, we have all shared a concern that people on low incomes should not be deterred from visiting their GP on cost grounds. In particular, we have agreed that parents should not be deterred on cost grounds from bringing their children to the GP. The Government is now acting to address these concerns.
The doctor-visit card will take away for individuals and families any concern about the cost of bringing their child to a doctor or, indeed, attending themselves. People will be able to get the advice and reassurance they need from their GPs and, if necessary, be referred on to other health services in either the community or the acute sector, as necessary. It is often the case that when a child is sick, he or she is taken to the doctor when medication might not be necessary. Although medication might be unnecessary, the parent can be reassured by the doctor’s advice and we are now going to make that possible. The traditional medical card will continue to be held by some 85% of medical card holders. With this policy innovation, the same budget allows us to provide four times as many people with free access to their GP as with the traditional medical card.
It is important to remember that not all concerns or medical conditions with which people present to their doctor necessitate the prescription of medication, so in many cases no cost need arise in that regard. For those who require prescription medication, under the drugs payment scheme, no one need pay in excess of €85 in prescription drug costs in a calendar month. I am pleased that the Irish Medical Organisation has welcomed this initiative and I look forward to its co-operation in the introduction of these new medical cards, in the interests of the families and individuals concerned.
The Health Service Executive is preparing for the introduction of the doctor-visit medical cards and is drawing up appropriate operational guidelines to enable applications to be assessed on a standardised basis across the country. Once this legislation has been enacted, the HSE will be in a position to begin promoting the scheme and inviting formal applications, with a view to the first doctor-visit medical cards being issued during April.
The Government wants it to make it easy for people to apply for and use these cards. The Health Service Executive will do all it can to ensure this, including holding constructive discussions with the Irish Medical Organisation on implementation. The policy of the Government is absolutely clear. It is providing the resources to fund these new cards and is introducing the legislation underpinning them. The Government wants people to take up the new cards and visit their doctors as often as needed.
Income guidelines are set for the Health Service Executive for eligibility for medical cards on the basis of the best and latest income and expenditure information available for the population. The Health Service Executive intends initially to set the income threshold for the doctor-visit cards at 25% higher than applies for the standard medical card. The Department will monitor the uptake of the new cards closely to ensure that the many thousands of people whom we wish to have the cards actually apply for and receive them. If it is found that significantly fewer people than expected take up the cards because incomes are growing quickly, the 25% threshold will be reviewed to ensure that the desired numbers of cards are being issued. An allocation of €60 million has been provided for this initiative and must be spent as intended, as it will give assistance and reassurance to many families.
I should add that there is no question of the Government seeking overtime to reduce the number of standard medical cards in favour of issuing increased numbers of doctor-visit cards. This initiative is intended to complement the existing medical card arrangements, which have been in force for many years.
I now propose to outline the scope and principal provisions of the Bill. For the purpose of clarity I will deal with the long-stay charges first and then doctor-visit medical cards. The Bill is designed to eliminate the anomalies that have arisen under the current legislation for raising charges for long-term care in public-funded long-term care institutions. The Bill and regulations will promote consistency in the application of charges, with greater clarity for those receiving services and the public generally as well as promoting administrative efficiency and transparency throughout the system.
Section 4 provides for an amendment to section 53 of the Health Act 1970, which deals with the legal basis for the imposition of charges. It will replace the existing enabling provision in subsection (2) which provides the Minister with discretionary power to make regulations by a provision which requires the Minister to make regulations in order to impose charges regarding all persons, such as those with full and limited eligibility. Currently, section 53 of the Health Act 1970 provides power to make regulations to impose charges only on those who have limited eligibility.
Subsection (3) specifies the categories of persons exempt from charges imposed under subsection (2). Such categories include all persons under 18 years of age, those detained involuntarily under the Mental Health Acts, those in receipt of acute care in hospitals and those who, in the opinion of the HSE and pursuant to section 2 of the Health (Amendment) Act 1996, have contracted hepatitis C directly or indirectly from the use of human immunoglobulin anti-D or the receipt within the State of another blood product or a blood transfusion. We will introduce subsection (4) to empower the Health Service Executive to reduce or waive a charge on financial hardship grounds.
Subsection (5) clarifies that any current regulations currently in force under section 53 will remain so. The regulations in question are those that impose a hospital levy of €55 per day subject to a maximum payment in any 12 months of €550. These charges will continue to be inapplicable to people with full eligibility, medical cardholders, including all over 70s, and a series of other exemptions such as women in respect of motherhood.
Subsection (6) provides that the charges shall only apply for inpatient services after a period of 30 days or periods aggregating 30 days within the previous 12 months. It also limits the weekly charge to an amount that does not exceed 80% of the maximum of the weekly rate of old age non-contributory pension. Subsection (7) clarifies that the period of 30 days referred to in subsection (6) begins immediately upon the provision of inpatient services to the person concerned. Subsection (8) provides that the charge shall be in respect of the maintenance aspect of inpatient services.
Section 6 repeals section 140 of the Social Welfare (Consolidation) Act 1993 in order to remove a conflict with the provisions of the Bill which exempt persons detained involuntarily under the Mental Health Acts 1945 to 2001 from charges for the maintenance element of inpatient charges in long-stay residential institutions.
I will now outline the Bill’s provisions on doctor-visit medical cards. Section 1 amends section 45 of the Health Act 1970 in two respects. In both cases the amendment aims to ensure an alignment of the legal principles governing the award of the standard medical card and those contained in the provision to be included in section 58 of the Act in respect of the doctor-visit card. Section 1(a) makes it explicit that the judgment as to whether a person meets the criterion of “undue hardship” specified in section 45(1)(a) of the Health Act 1970 is made by the Health Service Executive. Section 1(b) substitutes the existing section 45(2) of the Health Act 1970 with a wording that makes it clear that decisions on eligibility by the Health Service Executive must not be made by reference to a person’s means alone, but also to what constitutes reasonable expenditure on the person’s behalf. This is in line with existing practice in the Health Service Executive, whereby costs associated with such matters as a person’s employment, reasonable housing provision and the care needs of children or dependants, including nutrition and clothing needs, are taken into account in determining whether a person faces undue hardship in meeting the costs of GP services.
By amending the law in this way we are making it a legal requirement that a person’s reasonable expenditure needs are taken into account in the application of section 45(1)(a) of the Health Act 1970. In both cases these provisions reflect the HSE’s current practices with regard to the assessment of individuals for medical cards. These amendments will not, therefore, affect the processes and practices already in place as regards the award of the standard medical card.
Section 2 amends section 47 of the Health Act 1970 by adding a reference to section 58 along with the existing reference to sections 45 and 46. This is to ensure that the relevant appeals provisions extend to the scheme for doctor-visit medical cards. Section 3 amends section 47(1) of the Health Act 1970 to include the doctor-visit medical card scheme in respect of the Minister’s power to issue guidelines to assist in decisions on whether or not a person is ordinarily resident in the State. Guidelines were issued to the health boards in this regard in 1992 and remain in force.
Section 5 replaces the existing section 58 of the Health Act 1970, which deals with the making available of general practitioner services without charge, with a new provision. Subsection (1) will require the Health Service Executive to make available general practitioner services without charge to persons with full eligibility and those with limited eligibility for whom, in the opinion of the HSE, it would be an undue burden to arrange these services for themselves and their dependants. This provides the legal basis for the granting of medical cards, the scope of which is confined to patients’ attendance at a general practitioner.
Subsection (2) of the new section 58 specifies the same general requirement with regard to the making of decisions by the Health Service Executive in respect of doctor-visit medical cards as is being inserted regarding decisions on eligibility, that is, they must be made not just by reference to a person’s means, but also to what constitutes reasonable expenditure on the person’s behalf. Subsection (3) maintains the existing requirement that there be a choice of doctor for persons obtaining general practitioner services under section 58 and ensures that this applies to holders of doctor-visit medical cards as well as holders of the standard medical card.
With regard to charges for long-stay care, this legislation will bring clarity to an area which, as is now clear, has not been operating on a sound basis going back almost 30 years. This is a genuine move to provide that imposed charges for long-term care have a sound legal basis. The legislation will also ensure that the income flow from charges imposed to date is secured for the future and that it will continue to support the provision of quality services to those in long-term care. It has been accepted that these charges, as contributions to the cost of care, are fair and reasonable.
With regard to new medical cards, providing general practitioner cover to up to 200,000 additional people from lower income households in the way provided for in this Bill is effective social justice. We are providing graduated benefits according to income. It is much better that State benefits are not all or nothing. We know from our experience of reducing unemployment how important it is, for social justice reasons as much as anything else, to avoid poverty traps. Graduated benefits are a fair and effective way to help people at different levels of income. Government policy is based on a coherent and integrated view of economic and social progress. The new medical card is one innovation within that strategy and will stand the test of time for many thousands of people in the years ahead. I commend the Bill to the House.
Mr. Browne: I welcome the Minister of State and his officials. I am not sure what the Minister of State’s job was before he became a Deputy. However, I suspect after listening to him that he was involved in the building industry. He would certainly have a future as a plasterer because he has plastered over huge cracks in the Government’s health policy as if they did not exist and as if all the problems have been solved.
The Government has been dragged kicking and screaming back into this Chamber with the Health (Amendment) Bill 2005. When we had the previous Bill before us in December, the Opposition warned the Government there were problems with it. The Government did not listen, but insisted on pursuing the matter and rushing the Bill through both Houses of the Oireachtas. Not alone that, it had the audacity to request the President to sign it into law sooner than the normal five days. The Leader of this House passed the motion for earlier signature. Fortunately, in her wisdom, President McAleese refused to sign the Bill into law early. She called a meeting of the Council of State and referred it to the Supreme Court where it was found wanting, as was the Government. This forced the Government to return to the House with this replacement Bill today. It is deeply regrettable that it took the President and the Supreme Court to make the Government aware of the seriousness of the situation and the fundamental flaws in its original Bill.
The Minister of State’s speech was quite comprehensive, but I must raise some issues. He pretends that the Government welcomed the Supreme Court decision, but in reality it would have preferred that no case took place. It did not expect the court to find against the legislation. The Government had egg on its face in that regard. I must point out that while the investigative work of Fine Gael on this matter has resulted in a bill for the taxpayer, it has, no doubt, saved the taxpayer from a future massive bill. Had it not sought clarity on the issue, the illegal deduction of money would have continued for years until, perhaps, in 30 years time somebody caught the mistake. We can only imagine the size of the bill then. At least we have clarity on the issue now.
Fianna Fáil comes out badly from this issue. The Tánaiste admitted today that a former Fine Gael Minister, John Boland, when he was interim Minister for Health, noticed the difficulty with the charging of patients in nursing homes. He brought the issue to the Cabinet, but that Government fell and a new Government came in under the leadership of Charles Haughey with the Ceann Comhairle, Deputy O’Hanlon, as the Minister for Health. That Government should have introduced legislation to correct the problem but it was not done.
Senator Glynn referred to 1976. However, I believe the two main dates of relevance are 1987, when the Fianna Fáil Government came into power and failed to take action on the issue discussed by the previous Cabinet, and 2001, when the then Minister for Health and Children, Deputy Martin, introduced medical cards for all over-70 year olds, without consultation with the appropriate agencies or consideration of the long-term implications. The blame for this problem lies firmly with Fianna Fáil.
The Minister of State uses a word in his speech that reflects the Government’s uncaring attitude towards the elderly. He speaks about the cost of treatment and “maintenance”. He speaks about old people as if they were objects. In future, the Department should refrain from the use of the word “maintenance” when speaking about human beings. It is a cold and dispassionate word.
The Minister of State referred to the Government’s policy on development and delivery of services for older people. This does not match the reality. I visited his constituency recently where I met a lady involved in the home help service. She gave out to me because as a home help her travel allowance had been cut. I presume this has happened around the country. She also complained that patients were assigned a maximum of ten hours help per week, irrespective of their needs, and that the home help situation has been radically changed by the Government. The Minister of State’s words do not match the reality while the funding provided for the elderly is dismal.
The Minister of State also mentioned the new medical card scheme and that he hopes the new Health Service Executive will ensure a smooth transition. I understand there are major difficulties in this regard. Will the Minister of State clarify what talks have taken place so far in this area? Many general practitioners who have spoken privately to me have indicated that they foresee problems with the general practitioner-only medical card. They expect difficulties down the line. We must try to ensure that we avoid a repeat of the current debacle.
I am disappointed that the much publicised Bill on eligibility, about which the Tánaiste spoke here, does not appear to be any closer. I agreed with the Tánaiste when she stated there was a need for an eligibility Bill that would specify to what people were entitled. However, that Bill is not making any progress and we have a disjointed approach that will land us in more difficulty. It is important that the people know to what they are entitled. If this information had been provided years ago, we would have avoided the mess we are in today.
I understand that the two main differences between this Bill and the previous one are that the retrospective element and the medical card inclusion have been removed from it. The Government is being disingenuous on the medical card scheme. It gave a clear commitment in the most recent general election that it would increase the number of medical card holders. It has failed in that area and there are approximately 200,000 fewer people on medical cards. It is now introducing this “yellow pack” type medical card for general practitioner services only.
Fine Gael suggested this approach and the use of general practitioner-only medical cards, mainly to benefit parents who could not afford to bring their children to a doctor. If a child comes out in spots, parents need to know whether it is meningitis or a minor rash. The benefit of these cards is such that they will eliminate that worry by allowing such parents the freedom to visit their general practitioner. Unfortunately, the Government has hijacked this scheme.
Some people have said that these cards are only half a medical card. Significant benefits attach to medical cards such as free drugs, or exemption from exam fees for children doing leaving or junior certificate. A person on a general practitioner-only medical card will only get about one eighth of the value of a full medical card. The Minister of State’s words do not reflect the reality. It is shocking that the Government’s mishandling of the issue could account for almost one seventh of the Department of Health and Children’s budget this year which, in turn, accounts for one quarter of State expenditure.
Fine Gael has serious concerns about the legislation. It is amazing that only one amendment was discussed in the Dáil yesterday. One wonders whether the Government learned anything following the debacle prior to Christmas when legislation was rushed through the Oireachtas. Everybody agrees that rushed legislation is bad legislation, yet a short, important Bill has been introduced and sufficient time has not been allocated to debate it properly. Committee, Report and Final Stages will be taken together tomorrow even though the Leader is on record as saying that is a bad way to do business.
The consideration of undue hardship for entitlement to a medical card for those aged under 70 will be decided by the Health Service Executive under section 1(a). That will introduce a new layer of bureaucracy. Section 1(b) refers to the means test for medical cards and Fine Gael is concerned this provision might discriminate against married couples because a spouse’s income will be considered, which contradicts the Health Act 1970. Section 5 deals with traditional medical cards and doctor only cards.
If Deputies Perry and Kenny had not ruthlessly pursued this issue, we would not have reached this point. While the taxpayer might take a hit initially because of Fine Gael’s work, we have saved the taxpayer money in the long term. The worst aspect of this sorry saga is that the patients who could speak up for themselves were not levied charges but those who could not were. The Secretary General of the Department of Health and Children has been scapegoated in the Travers report but there should be greater political fallout because Ministers must be accountable.
Ms Feeney: The Senator should read the report because then he would know the facts. Nobody was scapegoated.
Mr. Browne: I read the report. Earlier on Leaders’ Questions in the Dáil, Deputy Rabbitte quoted the comments of Fianna Fáil Front Bench members, most of whom are now Ministers, in 1996 during a debate on a missing letter in the Department of Justice, Equality and Law Reform. Fianna Fáil firmly believed the then Minister was responsible but, according to the Travers report, that is not so in this instance.
The Tánaiste and Minister for Health and Children’s comments when she appeared before the Oireachtas Joint Committee on Health and Children were amusing. She stated the contradictory evidence given by Mr. Kelly, the Secretary General, and her predecessor, Deputy Martin, was of grave concern. However, she would not say who will adjudicate on it.
Ms Feeney: If the Senator read the report, he would have a better understanding.
Mr. Browne: Somebody is not telling the truth. When the Minister was questioned about whether she trusted Mr. Kelly and whether she had full confidence in her predecessor, she would not give a clear answer. That version of events will not wash with the public.
Ms Feeney: She gave a clear answer. She said she would not reply to a politician and that she would take it up with the Taoiseach.
Mr. Glynn: She did not give the answer the Senator wanted.
An Leas-Chathaoirleach: Senator Browne, without interruption.
Ms Feeney: He is misleading the House.
Mr. Browne: I am not misleading the House. When Deputy McManus asked the Minister whether she had trust in Mr. Kelly, she would not answer the question. She would not tell the committee who will adjudicate on the recommendations in the report.
Ms Feeney: It was not the arena in which to answer. Surely the Senator understands that.
An Leas-Chathaoirleach: Senator Browne, without interruption.
Mr. Browne: I look forward to tabling amendments on Committee Stage but I doubt they will be accepted. The Dáil will take a five-week break, unlike this House, which will resume the week after next. The manner in which the Government has rushed the legislation does politics no service, particularly by not allowing amendments to be debated fully on Committee Stage, not to mind Report Stage.
Mr. Glynn: I welcome the opportunity to contribute to the debate. The Bill provides for the amendment of the Health Act 1970 to address two substantive matters, namely, to provide a legal framework for the charging of patients for the maintenance element of in-patient services in publicly funded long-term care residential units and for the introduction of doctor-visit medical cards. The Government has introduced the legislation to establish a sound legal basis for the policy of requiring a contribution towards shelter and maintenance of people with full eligibility in long-stay institutions. All Governments and all parties in Government have supported and implemented this policy. The Supreme Court recently confirmed that it is constitutionally sound for the Oireachtas to legislate for this policy. The issue is finally being put beyond legal doubt after almost 29 years.
I welcome the Supreme Court decision, which found sections of the previous Bill unconstitutional in the context of people’s property rights. I do not agree with the approach taken by a small number of members of the medical profession. I have worked with the elderly for a long number of years. Many old people want to stay in the homes and communities in which they were born and reared. When they need care, the approach of a number of practitioners is that there are pills for all but that is not, nor should it be, the case.
The best community care service should be provided together with social supports, including support by families so that people are not consigned to care institutions and forgotten about. Regrettably, that has been the case too often over the years. The popular misconception is that care in the community involves private nursing homes, geriatric hospitals or welfare homes but I do not accept that because many community care models can cater for the elderly. However, that is a matter for another day.
Senator Browne referred to the uncaring attitude of Fianna Fáil but that is amusing when one considers that a few short years ago when Fine Gael was in Government it made Ebenezer Scrooge look like a benevolent Santa Claus with gleaming robes in terms of what it did not do for the elderly. It was a joke. I admire the Senator’s tenacity and hard neck to criticise a government that has been a flagship for the elderly.
Mr. Browne: Why is the Government cutting home help?
Ms O’Meara: The Government took money out of the pockets of the elderly. Is the Senator proud of that?
Ms Feeney: As did the Opposition parties.
Mr. Glynn: A Minister who went through several stages of political metamorphosis and wound up in the Labour Party presided over that debacle.
Senator Browne objected to the word “maintenance” but that has been around since Adam was a boy. He asked us to go back to 1976. As Senator Feeney stated, this issue is not all about what happened since 2001. A coalition Government was in power from 1973 to 1977. Fianna Fáil took over until 1981. A mixed gathering of parties and Independents took up office in June 1981. That Government fell in February 1982 and Fianna Fáil returned to power, subsequently losing power in November 1982. Senator Browne’s party was in Government from 1982 to 1987; then Fianna Fáil came back until 1992, and from that point until 1997 the Senator’s party was in power. Several Governments have presided over this, and something should have been done about it. To the credit of the incumbent Minister for Health and Children she has attempted to do something about it.
Mr. Browne: Unlike her predecessor, Deputy Martin.
Mr. Glynn: The Senator carped about the Independents, but if his colleagues in the Lower House had not indulged in speeches on Second Stage, which amounted to mere filibuster, the Senator would have reached the salient point in the amendment. If the Senator wants to do the same in this House, and waste his own time, that is his prerogative.
A medical card is a very important facility as it has many ancillary benefits. The Minister has been criticised for the medical card approach. Everyone in public life is aware of what it costs to go to a general practitioner. GPs have their own overheads and the cost of their service is expensive. A significant step forward has been taken in terms of the people who want to benefit from medical services. Medical cards are entirely dependent on income. In the case of terminal illness, if medical evidence can prove a consequent financial hardship, a person may be entitled to a medical card but income is still pertinent.
The Minister has given a clear statement on the Bill’s contents. The decision of the Supreme Court on 16 February 2005 in the matter of Article 26 of the Constitution on the Health (Amendment) (No. 2) Bill 2004 has brought clarity and finality. It paved the way for this Bill to provide the legal basis for charging for inpatient services in publicly-funded, long-stay institutions. The community as a whole will benefit from that decision. That was not the first Bill that passed through these Houses and was then deemed unconstitutional and it is unlikely to be the last. We had a full debate on the Supreme Court decision two weeks ago. The Supreme Court found that the provisions of the Bill that provided for prospective charging for inpatients was not repugnant to the Constitution. There is no Constitutional prohibition on the implementing of a charge for public long-stay inpatient services. The Government also accepts that the Supreme Court found the retrospective provisions of that Bill, making lawful the imposition of such payments in the past, to be unconstitutional because it concerned the property rights of the citizens. The Tánaiste said she could not stand over this position and I agree with her.
Today, our focus is on the implementation of future policy. If one learns the lessons of history, one is less likely to repeat mistakes. A significant feature of our system of publicly-funded, long-term care is the principle that people should make some contribution to the cost of their care. This reminds me of the Army deafness claims, with which former Minister for Defence, Deputy Michael Smith, dealt. Similarly, this issue must be dealt with. All past Governments have failed to do so to a greater or lesser extent. I welcome this Bill. Some politicians and solicitors have begun chasing ambulances. In my Mullingar constituency I meet people, who never visited their elderly relatives, who ask me how much they will get. On the record of this House I have warned that such people will come out of the woodwork seeking money, although they never took time to visit people in those institutions. I commend the Bill to the House.
Mr. Quinn: A good measurement of a democracy is how a State looks after those who are unable to look after themselves. This is most evident in the area of health. I am aware that one hospital in Ireland has asked the public to stay away, due to the third outbreak of the winter vomiting bug in three months. I contrast this with hospitals in Britain; they have league tables for hospitals and this has reduced the instances of MRSA infection dramatically. Compare this to Denmark, which has no instances of infection because hospital beds are washed after each patient. This is a reminder that the way we care for the health of our citizens should be a priority. It is a measure of whether we deserve the term “democracy”. I have no problem with this Bill but am more concerned with its background and the way it is being rushed through the Oireachtas.
I would have thought that the bad experience we had with the Bill’s predecessor would have given the Government pause before again trying to rush through another measure. There may be no doubt about the constitutionality of what is before us now, but a Bill can be fully constitutional and still be bad law. It is all the more likely to be bad law if it is rushed. I accept that delay costs the State approximately €2 million for every week that the Bill is not enacted, but that is not a sufficient excuse for rushing it through.
I have no problem with the idea of charging people for nursing home accommodation. The State hands out old age pensions on the basis that the people receiving them have to provide a roof over their heads. When the State takes over this responsibility it is fair that some of the pension should be clawed back. Very few reasonable people would disagree with this, even those whose money was wrongly taken over the past 30 years.
What was wrong about those charges was not that they were unfair or unreasonable but that they were illegal. They were imposed in flagrant defiance of the law, which has until now specifically proscribed such charges. It is important to bear in mind who was breaking the law. Many laws are broken every day by citizens who, for the most part, are brought to book. The law is not called into question because some people break it and still less is our democracy threatened by such actions. However, it is very different when the law-breaker is the State.
What defines a democracy is not having elections, or elected representatives, or even having a legislature. Beneath those trappings is something more fundamental, and that is the very thing we have spoken about today, namely, the rule of law. We speak of it because of the statement from P. O’Neill yesterday and we realised how important the rule of law is. In a democracy, people do not rule, the law rules and everybody, without exception, is subject to it. All of us must be bound by the law, whether we are citizens, legislators, administrators, Ministers or members of the Judiciary. Even those of us who have the privilege to make laws, as we have in this House, are bound in what we do by a more fundamental law, namely, our Constitution. We found that out within the past month. It is simply not open for us to say, as if we were Humpty Dumpty, that the law is what we say it shall be. If lawmakers break the fundamental rules that bind us, we are quite rightly held to account.
The law is supreme. I am sorry if I am going on about this but, above all, this supremacy applies to the State itself. If the State can be above and beyond the law, we have no democracy worth talking about. It is nothing but an empty sham. If the law does not protect us from arbitrary actions by the State then we do not live in a democracy, no matter how many elections we might have or political parties to contest them or however free our media may be. A democracy is a state where everybody, including the state, is obliged to conform to the law.
Apart altogether from that consideration, it is surely in the State’s own interest to uphold the law. If it expects its citizens to be law abiding, then it should set a good example. It should uphold the rights of citizens, not trample them under foot. This is why we must take the question of the nursing home charges with the utmost seriousness. We must do so not because they were unfair or unreasonable but because they were illegal and this illegality was perpetrated by the State.
This issue is made all the more serious because this was not a once-off happening. It was not a temporary aberration that was quickly noticed and immediately corrected. This was something that went on for nearly 30 years without anybody putting a stop to it. That length of time makes the whole situation worse purely in terms of size. With each passing year the sum of money involved became significantly greater. The problem of doing something about it quite soon turned into a vista that was appalling in its magnitude alone. No doubt this will be argued in mitigation.
Surely the most appalling aspect of the entire affair was that this was not something that happened in secret. This was not a sinister plot that was hatched in the depths of the Department of Health and Children, however culpable some of that Department’s administrators may have been along the way. It now becomes clear that the legal basis of these charges was something that was known about right from the beginning.
Everybody is now rushing to cover themselves, to argue that they knew nothing about what was going on. Everybody today is busy scanning the 160 pages of the Travers report, looking for convenient scapegoats. I cannot join in that witchhunt because I am as guilty as everybody else in this matter. I suggest this guilt is shared by every other Member of this House and of the Lower House as well. We can argue about how difficult it is to hold Ministers to account. No doubt Ministers, in turn, will argue that they cannot know everything that their civil servants do. To make such arguments is beside the point. We can all read and, despite the amount of paperwork that descends on all of us all of the time, there are certain things we have a duty to read. They include the reports of the Ombudsman. When we look back over the reports of every Ombudsman who has held office, we see this malpractice held up before our eyes in the clearest possible terms.
There was no secret. It was a public scandal that was repeatedly publicised by each Ombudsman. We cannot claim that it happened out of our view or that these events were beyond any possible oversight that we as legislators could be expected to exercise. Ombudsman after Ombudsman cried out to us but, as legislators and as citizens, we chose not to hear.
In giving the nod to this legislation, let us not think that we are disposing of the matter. Let us not fool ourselves into paying out €2 billion in compensation and think that will undo the damage that has been done. Long after this Bill is enacted, long after the last pensioners, or their descendants, have got their money back, I suspect this question will be around to haunt us. How could we let this threat to democracy happen right before our eyes and not do something about it?
We are doing something about it now and obviously it is better late than never. I am not sure that it is right that we have been dragged into doing it on a second attempt. We have nobody to blame but ourselves and therefore I am not looking for scapegoats. I am accepting responsibility, as I believe each one of us should do.
Ms Feeney: I welcome Minister of State at the Department of Health and Children, Deputy Brian Lenihan. I am delighted to speak on the Health (Amendment) Bill 2005. It is a short Bill with two purposes. First, to put reasonable charges for long-stay care on a legal basis and, second, to provide hundreds of thousands of people on low incomes with the opportunity to visit their GPs without worrying about costs. These two issues are most welcome and I am delighted that we, as a Government, have brought forward proposals today in this regard. Now we, as a Parliament, must ensure there is legal clarity regarding important public services and charges.
While many people have ranted and raved about this issue since it first came to light last year, I commend the Tánaiste and Minister for Health and Children, Deputy Harney, the Ministers of State, Deputies Brian Lenihan, Seán Power and Tim O’Malley, and the entire Government for bringing these proposals to us. I will say again that I welcome the decision of the Supreme Court. Senator Browne would see that differently. He thinks we on this side of the House pay lip service and say we welcome it when, in fact, we do not. It has certainly given us clarity on where we are today.
This Bill, as the Tánaiste and Minister for Health and Children, Deputy Harney, stated in the Dáil last week, stems from the Government’s determination to provide legal clarity in the interest of patients, their families, taxpayers and better public administration.
It goes without saying that I support the proposed changes outlined in the Bill. This sets about creating legal clarity regarding public services and charges. Everyone concerned, and that includes patients, their families and members of the public, deserves to know exactly what the legal situation is. That is why I believe this debate should be calm and reasoned. As politicians, we need to reassure the families of current and deceased patients. This will not be done by scaremongering and trying to score cheap political shots. Every Government in office within the past 30 years is involved in this issue. I am proud that at last it is this Government that is taking the bull by the horns and trying to address the matter.
On the repayment of past charges, the Government is working on a scheme of repayments that will be effective, user friendly and as automatic as possible. Only last week, I spoke in the House on the high level sub-committee the Minister has put in place to examine this issue. This cannot be done overnight, but it is everyone’s wish, and the wish of the Government, that it is done as quickly and effectively as possible. The practicalities and legal issues surrounding the repayments are currently being worked out by the sub-committee. I am glad the Supreme Court covered this issue in its decision and stated there is no need for it to go to another court.
I laugh when I hear members of the Opposition talk about money being robbed from the people involved.
Ms O’Meara: I would not be laughing.
Ms Feeney: It might suit the Senator to shout at us to go back to 1976. Of course we go back to 1976——
Ms O’Meara: Did the Senator read the report?
Ms Feeney: The Opposition is as responsible as any other Government for what happened in those days.
Ms O’Meara: Muck-spreading will get the Senator nowhere.
Ms Feeney: Yes, they were. If they read the Travers report——
Ms O’Meara: I have done so.
An Leas-Chathaoirleach: Senator Feeney, without interruption.
Ms Feeney: They are only going through the Travers report now. We read it this morning.
Ms O’Meara: Good for them. I have a great deal to quote from it.
Ms Feeney: They will see that section 4.25 points that out. It brings us all back to 1976 when it states that the practice did not derive from the Health Insurance (Amendment) Act 2001.
Mr. Bannon: How many incompetent Ministers have we had over the last seven years who ignored the problem? Had it not been for Deputies Perry and Kenny, this would never have been brought to public knowledge.
An Leas-Chathaoirleach: Senator Feeney, without interruption.
Ms Feeney: Lord, where would we be without Fine Gael?
Senator O’Meara can turn to section 4.25 of the report now and see where Mr. Travers has asked us to bear in mind that the practice did not occur only after the passing of the Health Insurance (Amendment) Act 2001. It had been in place since 1976. I do not say that, it is said by Mr. Travers, the consultant.
Ms O’Meara: How very convenient.
Ms Feeney: Senators will either accept his report or not. This is not AIB. There is no one making money and there was nothing to be gained for anyone here. That point must also be borne in mind.
Ms O’Meara: There is a great deal to be lost.
Ms Feeney: On the overall issue, there is no doubt that it is reasonable for people in long-term care to make a personal contribution. As Senator Quinn has rightly pointed out, no reasonable person would disagree with that.
Section 4 provides for new medical cards that will make GP services free for thousands of people. I heard members of the Opposition as late as half an hour or 20 minutes ago making snide remarks and sneering at the cards, which they dubbed “yellow-pack cards”. I believe that it is not only wrong on their part but an insult to the thousands of people who will be entitled to one. I also heard Senator Browne saying that it was their initiative and that the Government had hijacked it. I briefly left the Chamber to get someone in my office to look for what was either a Fine Gael or Labour Party Private Members’ motion before Christmas. I think that it might have been a Labour Party one. During the debate, we discussed medical cards.
Mr. Bannon: The Senator should get her facts right before she puts matters on the record.
Ms Feeney: I took part in the debate and I remember asking the Tánaiste whether she could examine a system whereby families might be entitled to medical cards for either GP or pharmacy services only. A week later, I heard the Fine Gael spokesperson, Deputy Twomey, come out with it. I say to Senators Browne and Bannon that the Government did not hijack anything. On the contrary, they hijacked my idea but I have been modest enough not to have said so hitherto. I bring it up merely because they are the fellows——
Mr. Bannon: Let us sack the Minister and bring in the young Senator.
An Leas-Chathaoirleach: Senator Feeney, without interruption.
Ms Feeney: ——banging the drum on the other side of the House. At present, there are families who cannot afford to bring their children to the local GP because of the high cost. People on low incomes, as we have said in this House, must prioritise what money they have. I am happy to see that these proposals will allow them access to their GPs without worrying about costs.
I look forward to the Bill’s next Stage and wish the Government and the Tánaiste well. I welcome the Travers report, which is extremely interesting for those of us who have taken the time to debate and read it today.
Ms O’Meara: I welcome the Minister of State to the House to debate this very important legislation. We are here again with this Bill on the thorny subject of charges levied on long-stay patients in public institutions. Let us not forget that we are talking about elderly people who were charged — illegally, as it now turns out. We now know from the Travers report that it had been known about since 1976. I agree that the report states that the Department had been aware from that year that such charges were illegal.
I wish to return to the Travers report and make remarks in that regard in the context of a Second Stage speech on this Bill, as it refers to the specific issue. Let us remember that we are talking about elderly people with eligibility and let us consider the situation before the extension of medical cards to the over 70s. Even before then, eligible people were being charged for staying in institutions.
Another Senator referred to people recently crossing the threshold of his office in Mullingar who had not been paying much attention to their elderly relatives and now wondered whether they might get a few bob out of them. The Senator might be interested to hear that I can recall a woman who came to me several years ago in sheer desperation. She was separated and had a teenager doing his leaving certificate, circumstances that, one might have thought, put enough pressure on her. She was on a low income and her elderly father, who was in need of care, was in a public institution. She was not only getting bills from the institution; she was receiving sharp and threatening letters that caused her deep distress and upset.
When she came to see me she was distraught because she was constantly getting letters from the health board demanding payments for the care of her father which, it now transpires, were illegal. There was clearly no question of his being able to pay and she simply could not pay. I do not think that any compensation could make up for the distress caused to that woman and she is only one example of the situation that obtained and the pressure under which families were put by what we now know was an illegal approach emanating from the Department of Health and Children.
The Travers report makes for extraordinarily grim reading. Unlike Senator Feeney, I have not had the privilege of spending hours listening to the Tánaiste and Minister for Health and Children, Deputy Harney, or perusing the report from beginning to end. However, from what I have read of it, I am extremely disturbed at what has been revealed. As Senator Feeney said, and as the Travers report makes clear, the Department of Health and Children was aware of a serious question mark over the legality of such charges.
However, the issue came to a head around 2001, when the South Eastern Health Board brought to the attention of the Department — because it had to — its extensive legal advice regarding patients in public nursing homes. It then became a major issue in the Department. Then we heard one extraordinary series of events set out by the Secretary General of the Department and a completely different series set out by the former Minister for Health and Children, Deputy Martin. It effectively amounted to a conflict of evidence.
I do not think that we will ever know what happened, but the core issue is that the file disappeared following the famous management meeting at which, it would appear, a decision was made. It is interesting to note that the then Minister of State, Deputy Callely, undertook to brief the Minister and the Taoiseach on the serious issues arising from the meeting regarding that discussion in the absence of the former Minister. It is, therefore, extraordinary to discover that the former Minister, Deputy Martin, said at the very end of his statement that it had not been drawn to his attention, either formally or informally, at any time.
One wonders how business was being done in the Department of Health and Children and how, within a short time of her arrival in the Department, the Tánaiste, this having been brought to her attention on the floor of the House by Deputies Perry and Kenny, was able to get a grip on it very quickly, seeing that action needed to be taken. How was it that there was such inability to communicate properly with the former Minister for Health and Children, Deputy Martin, on such an important issue? It is impossible to understand the reason the Department did not appear to be able to get it through to the Minister, if that was what was required, that this issue needed to be dealt with. The situation was that the Minister was not informed of it, yet according to the notes made at the famous management meeting held in the Gresham Hotel, the Minister of State, Deputy Callely, undertook to brief the Taoiseach and the Minister. I wonder what happened in regard to that briefing, when it took place or to what it amounted.
Another issue of major concern in the report that must be highlighted is the way the Department of Health and Children handled this issue. From my experience as a public representative I am aware that people who refused to pay the charges — the Ombudsman’s report notes this also — did not have to pay them despite being sent threatening letters and so on. Page 88 of the report states:
What kind of practice are being referred to here? It appears to be one of when challenged, settle and under no circumstances be accountable or responsible. That way of operating in a Department is appalling. Are other Departments using a similar stratagem?
Mr. B. Lenihan: Or local authorities.
Ms O’Meara: Or local authorities indeed. Is this practice endemic? Do they just chance their arm and if they are challenged settle but under no circumstances do they stand up and take responsibility because they know they will be found out? Where else is this practice operating?
The Minister of State mentioned local authorities. We must ask if this practice is endemic in Irish public life. Those of us who were members of local authorities and who have encounters with Departments know that certain informal practices have built up over the years and here, in black and white in this report, is one of them which, as Senator Feeney rightly pointed out, is appalling.
Mr. Dardis: The Senator does not want to include the South Eastern Health Board in those categories.
Ms O’Meara: I thank Senator Dardis for that remark.
I draw attention to page 89 of the report which deals with findings. I refer again to the inability to communicate effectively with the Minister for Health and Children at the time. The report states:
Clearly, some decision was made to draw up heads of a Bill. From my limited experience of having worked with a Minister, I thought that when heads of a Bill were drawn up it was usually with the agreement of the Minister. I do not have direct experience of the Department of Health and Children but it appears that practices in the Department were extraordinary if this report is anything to go by.
We are not discussing the Health Service Executive in this legislation but the framework of legislation now required on foot of the Supreme Court judgment and everything that has been revealed. What will now happen, given that,effectively, the entire administration of the Department of Health and Children has been transferred to the Health Service Executive? The reference in the report to the speed at which decisions were being made is notable. Pages 51 and 52 refer to the wanderings of the famous folder around the Department and the various desks on which it ended up. The Secretary General, in his statement, states: “My view then and now is that this was a period of corporate and personal overload where the Department attempted to get through too much in too little time”. That is some admission. He further states:
If the Department attempted to get through too much in too little time there was a system failure. Effectively, a system overload resulted in system failure, one of the consequences of which is the disappearance of a file.
The statement by the then Minister in the report refers to the period when the famous management meeting took place in the Gresham Hotel. In his statement he provides a backdrop — page 53, third paragraph — and refers to the——
Mr. Dardis: This is all very relevant to the Bill.
Ms O’Meara: I said at the outset — perhaps it was before Senator Dardis came into the House — that this is all the same area. Unfortunately, I will not be in a position to attend the House tomorrow to contribute to the debate on the Travers report so I hope the Senator will bear with me.
Mr. Dardis: The Senator is getting her retaliation in first.
Ms O’Meara: Exactly. I am sorry that is the case but c’est la vie. In his statement the Minister talks about the backdrop to the 16 December 2003 meeting. He states:
The Minister of State, Deputy de Valera, who is now in the Chamber and very welcome, will recall that in October and November 2003, big marches took place on the streets of both Ennis and Nenagh. It is clear that the Hanly report was the major political issue then and this other issue was a smaller one.
This also raises the matter of attempting to get through too much in too little time. It was a major point of political pressure in terms of the health reform programme but my concern is that we rushed through legislation to set up the Health Service Executive without members of a board and a five year business plan being in place. In light of this report, it appears the establishment of the executive was at the very least premature. We will have to examine how issues such as corporate responsibility and accountability are now managed by a board which is not in the Department of Health and Children. I would like to hear the Government’s response on that. To give a roundabout answer to the comment made by Senator Dardis, the Travers report and the set of issues it raises are very relevant to the legislation before the House.
On the doctor-only medical card, which is not a bad idea, speaking as a public representative I hope it works. I hope it will give relief to those who need it most because I know, and I am sure others know also, that there are people who do not visit their general practitioner because they cannot afford it. There are those without medical cards who do not bring their children to the GP for that same reason. I hope we are going far enough in this legislation to ensure that aspect is covered.
It is to be hoped that the impact of the scheme will be to generate some relief on the pressures facing the hospitals’ accident and emergency units. If people feel they have greater access to their GPs they will be less likely to attend an accident and emergency unit or to wait until such time as they need to do so rather than having it dealt with early and effectively by a GP in a primary care capacity. I will wait to see how it will work in practice.
Our provision, through the public system, for care of the elderly is woefully inadequate. In light of the fact that the Hospital of the Assumption in Thurles is being upgraded at one level, which is welcome, but that, at another, the number of public beds is being reduced from over 100 to 70, one must ask serious questions about the Government’s commitment in respect of care of the elderly.
Mr. Dardis: I welcome the Minister of State, Deputy de Valera. I also welcome the Bill which, at one level, is essential, particularly as it rectifies the deficiency that has existed in the system for 30 years. An attempt was made to rectify this deficiency before Christmas and it is important to state that the Supreme Court did not find the practice of charging unconstitutional. The court did, however, find the retrospective aspect unconstitutional. The latter is an important point because there seems to be some suggestion in certain quarters that the practice was unconstitutional but that is not the case.
The Bill is also essential in terms of giving legislative effect to a decision to provide GP-only medical cards. This, however, was not imperative in the same way as rectifying the original defect in the system. That is why the Bill is important and why it must be passed by the Houses.
I accept that it is impossible to consider the Bill in isolation to the Travers report because it derives from the subject matter thereof. It underlines an important principle which is dealt with in the opening pages of the report, namely, that of perceived fairness. The report refers to the “perceived fairness of requiring a reasonable financial contribution to the costs of public health services on the part of those persons receiving such services taking account of their ability to make such persons”. That principle has been outlined on several occasions, particularly in the health strategy published by the Government in 2001 which states, “It is fair that all those in receipt of publicly provided residential long-term care should make some payment towards accommodation and daily living costs, if they can afford to do so, just as they would if they were living in the community”. I do not believe there is any dispute between various political perspectives on that matter. Most reasonable people accept that those who are in a position to subvent their care should do so.
A legal defect existed and it is to the credit of the Tánaiste and Minister for Health and Children and others, including Deputies Perry and Kenny, that this was identified and, more importantly, that action was taken to rectify it. It is not as if the identification of the defect is something new. That had happened as long ago as the mid-1970s. Section 1 of the Bill deals with full eligibility. Part of the difficulty that arose related to the concepts of full and limited eligibility and how they apply.
The Tánaiste is to be commended for acting quickly to rectify the defect. We have had one attempt at doing so which was struck down by the courts, the independence of which we accept, and we have now been presented with a second one which, I hope, will prove successful. A certain determination and an acceptance that things had been done incorrectly was required in order to do what the Tánaiste has done. The Travers report, which apportions blame, represents a manifestation to get to the bottom of this matter. The report is unusual in that it is concise, explicit, makes findings and, perhaps, will teach us some lessons about tribunals and their inadequacies.
Ms O’Meara: It is extremely well written.
Mr. Dardis: Yes. For one person to undertake to compile the report and to complete it within such a short period is a monumental achievement, particularly in light of the number of years that were the subject of investigation and the amount of documents to be examined. Mr. Travers is to be congratulated for what he has done.
The constitutional imperative means that we are obliged to provide resources and to ensure there will be reasonable expenditure in respect of people. There is an important aspect of the Bill which dates back to what was originally intended to be dealt with by the chief executive officers of the health boards and which is now being dealt with by the Health Service Executive. Section 4(4) states:
It is vital, particularly in the area of health, that people who are independent should have discretion to adjudicate as to whether someone should be liable for payments or whether they should be exempt. This is an important part of the Bill and I welcome it.
On the basis of the figures furnished to the Joint Committee on Health and Children earlier today, I understand that some 315,800 people, or their families or estates, will be eligible for repayments as a result of what has happened. This will expose the State to a potentially huge financial bill of between €500 million and €2 billion. I cannot understand how, as the report appears to indicate, people knowingly allowed this matter to drift to the point where the State could be exposed to such a massive extent.
If I understood what was said earlier today correctly, several political points were made as to culpability in respect of this matter. It is worth pointing out that six of the 16 Ministers who held office during the period of 30 years in question represented parties other than Fianna Fáil. Of these, only one, the late John Boland, who served in the interregnum between Governments as an interim Minister for Health, brought this matter to the attention of the then Cabinet. The report is explicit in terms of apportioning culpability. It states:
That is quite an explicit statement. The report proceeds to state that long-term systemic corporate failure occurred.
Senator Quinn made an important point regarding the supremacy of the law. We are all subject to the law and it is impossible for the Houses, the Government or local authorities to act ultra vires. Apart from the late John Boland, the legal advisers within the Department come out of this matter with considerable credit. It is obvious that over a sustained period, they were concerned about this matter to the point where they wanted action taken in respect of it. It is obvious that the South Eastern Health Board, as well as some of the other health boards, had similar concerns. Where did the blockage come from? When it reached a certain level, it just seemed to remain static. That was wrong and now we are paying the penalty. The Bill is important as it rectifies a situation that should have been cleared up a long time ago.
Some 200,000 people are eligible for free GP services. I hope that the free service will have a positive effect on the number of people presenting at accident and emergency departments. It is undoubtedly the case that some people are going to accident and emergency who could be treated by their GP. It would be preferable for them to visit the GP before presenting at accident and emergency, so that the doctor could make the referral. Many of these patients would be discharged rather than block up the system. Approximately 29,000 people presented to the accident and emergency department in Naas General Hospital last year. Kildare has a population of 160,000 people, so such a statistic represents a huge proportion of the population. One has to wonder why that happens.
This Bill also rectifies the deficiency regarding nursing homes. It fulfils the commitment of the Government to provide free GP services to those who are eligible. It deserves a quick passage through the House and should be enacted as soon as possible.
Mr. Bannon: I welcome the Minister of State, Deputy de Valera, to the House. When this Bill was debated in the Dáil this morning, the Tánaiste and Minister for Health and Children did not turn up. I am disappointed that she has not turned up to this debate this evening either.
Mr. Dardis: The Senator is not entitled to refer to someone who is not in the House. He has no knowledge of why the Tánaiste is not here.
An Cathaoirleach: Senator Bannon’s remarks are out of order. A Minister is present and there should be no reference to anyone who is absent.
Ms Feeney: The Senator should withdraw his remarks about the Tánaiste.
Mr. Bannon: I acknowledge the presence of the Minister of State. Since the current Minister for Health and Children took up her portfolio, the inadequacies in the health service have become more obvious. Cutbacks, nursing home nightmares, medical card disasters and waiting lists are all more prevalent. I support the comments of my colleague, Senator Browne, on this Bill. It is a desperate attempt by the Tánaiste to cover her tracks and gain legislative respectability, which the original rushed Bill failed to provide. This is evident everywhere and I acknowledge the President’s contribution in referring this legislation to the Supreme Court. I also acknowledge the efforts made by Deputy Perry and my party leader, Deputy Kenny, in chasing this up. These two men continually pursued this issue. I acknowledge the compliments paid to both men by Senator Dardis.
Mr. Dardis: The Senator will naturally reciprocate such compliments to the Tánaiste.
Mr. Bannon: There are critical questions to be asked about the former Minister for Health and Children, Deputy Martin, and his knowledge of the legality of charges on public nursing home patients. On several occasions, Senator Dardis stated that the issue was brought to the notice of the Minister’s civil servants. He acknowledged the statements by the late John Boland at an early stage.
Mr. Dardis: I never mentioned Deputy Martin, good, bad or indifferent.
Mr. Bannon: From the report, it is clear that on a number of occasions, the former Minister for Health and Children, Deputy Martin, might have been briefed on the legal doubts about these charges. In December 2000, a political decision was made to introduce automatic medical cards for people over 70. According to the Comptroller and Auditor General, a decision was communicated to the Department of Health and Children by the Department of Finance only a few days before the budget. The legislation to enact this decision was then the responsibility of the Department of Health and Children. Did the Department signal to the Minister the implications of this decision on levying charges on patients in long-stay facilities? In March 2003, an extract from legal advice obtained from the South Eastern Health Board on the legality of these charges was given to the Department. Given the gravity of that advice, was the issue brought to the attention of the Minister? I presume it was, but it was not acted upon.
Action should have been taken on several occasions to save taxpayers money. This seems to have been overlooked for short-term gains by the Government parties of the past eight years.
Ms Feeney: Fine Gael formed part of some of those Governments over the past 30 years.
Mr. Bannon: Rather than dwell on this ground which was comprehensively covered by Senator Browne, I would like to look at the broader ills of the health service which the Tánaiste has failed to address. In my own area of Longford-Westmeath——
An Cathaoirleach: The Senator should only speak to the Bill.
Mr. Bannon: This is relevant to the Bill and I will explain why. The official announcement of the closure of the ear, nose and throat clinic for the Longford-Westmeath area was made only three days ago. This was flagged in the Hanly report and in several statements by the Minister.
Ms Feeney: The Senator must stick to the Bill.
An Cathaoirleach: Parochial matters are not relevant to this Bill. I ask the Senator to address the Bill.
Mr. Bannon: Provision is made in this Bill for the reduction in travelling costs for carers and home help. This is particularly evident in one section of this Bill. No Member has highlighted this so I would like to do so. The current Minister has run around the country delivering whitewash, yet has done very little for the health services in the midland region.
Mr. Dardis: If the Minister can deliver whitewash, then the Senator can deliver slurry.
Mr. Bannon: She can mop it up any way she likes.
An Cathaoirleach: The Senator must speak to the Bill.
Mr. Bannon: Senator Dardis can package it any way he likes for the Minister, but she has failed to deliver. That we have a new Bill before us today represents negligence on the part of the Minister. I would like Senators to acknowledge that. On several occasions the Minister was told——
Mr. Dardis: The Senator should not get excited or he might wind up in accident and emergency.
Mr. Bannon: In November 2001, the then Minister for Health and Children published his long awaited health strategy amid great fanfare. I was a member of the Midland Health Board and I refused to attend the launch because of the waste of money the event represented.
Mr. Dardis: I am sure the Senator never went to a conference in his entire career.
Mr. Bannon: The strategy promised new legislation to provide for clear statutory provisions on entitlements. The promised legislation was supposed to provide a clear framework for the financing of long-stay care for older people. In preparing that health strategy, was the issue raised of the legality of charges for long-stay patients? The 2002 annual report of the Ombudsman stated clearly that a patient with a medical card was not liable for charges because he had full eligibility. The implication of this decision on the legality of charges was significant.
An Cathaoirleach: I must interrupt the Senator as Private Members’ business is to be taken now in accordance with today’s Order of Business. I ask the Senator to move the adjournment of the debate, which will be resumed at the conclusion of Private Members’ business. Senator Bannon will have two minutes left when he resumes, if he comes back.
Mr. Bannon: Two minutes?
An Cathaoirleach: Yes, you have spoken for eight minutes.
Mr. Bannon: I will be back.
Ms O’Meara: I move:
—recognising the huge difficulties faced by working parents in securing child care for their children and meeting the huge costs that the Taoiseach has acknowledged can be as much as €800 per child per month;
—deploring the failure of the Government to take the necessary steps to ensure that there are sufficient child care places available;
—expressing serious concern at the threat by the Government to withdraw staffing grant assistance under the equal opportunities child care programme currently provided to community-based/not for profit child care centres;
—calling for the withdrawal of this threat as without the grant aid huge increases in charges will be necessary and many centres may be forced to close; and
urges the Government to recognise the need for a child-centred and learning based system of child care and pre-school education that would respect parents’ choices, while allowing them to manage better the demands of both work and home, and that would have as central features:
I welcome the Minister for Justice, Equality and Law Reform, Deputy Michael McDowell, to the House to discuss this important motion. As the Minister will be aware, child care is emerging as a key issue in people’s lives. It is not surprising that it has also emerged as a major issue on the doorsteps during the by-election campaigns in Meath and Kildare North.
Many young working couples are finding themselves under severe financial pressure due to the high cost of child care and the Government’s failure to support working parents in alleviating such costs. In addition, the Government has failed to use investment in child care to tackle disadvantage effectively. Nonetheless, there is a great opportunity to do so, particularly via the equal opportunities child care programme, about which the Minister made an announcement last week.
The amendment to this motion sums up the Government’s attitude to child care. It reveals starkly the Government’s threadbare approach to the development and implementation of a meaningful child care policy that would reflect our economic prosperity and status, as well as our potential for economic growth. Such a policy would also put in place a network and infrastructural support system to enable every child to meet his or her potential.
The Government amendment refers to “the very significant increase in child benefit” and “the use of child benefit as the most equitable way of giving support to parents towards the cost of rearing and caring for their children, irrespective of the family’s employment status”. It is clear from this amendment that the Government sees child benefit as a mechanism to put money in parents’ pockets which would go towards the cost of child care.
I am in receipt of child benefit which amounts to €131 per month but it does not pay for my weekly child care costs. It falls far short of them, in fact. Child benefit, however, should not be seen as a mechanism to pay for child care; it is to support parents in raising their children, whether or not those parents are at work.
The Minister is a parent himself and knows the high cost of raising children these days. The sum of €131 per month is welcome and one must acknowledge the increase in child benefit in recent years. However, when one takes from that sum the child costs, as opposed to child care costs, it leaves very little for child care. At the rate of €131 per month it cannot be argued that child benefit is an effective mechanism for meeting the cost of child care.
Only last week in the Dáil, the Taoiseach told the Labour Party leader, Deputy Rabbitte, that child care costs are very high. They can be as high as €800 per child per month, which is higher than the cost of many mortgages.
I have encountered this issue much more than I thought I would on the doorsteps in Kildare North, in particular. Currently, a spouse, usually the mother, leaves work because when child care costs are deducted it is not worth maintaining two jobs in a household, along with juggling the responsibilities of caring for small children. There are other issues concerning family-friendly work policies, including flexible working hours and parental leave, which can assist people as they struggle with their responsibilities both as workers and parents.
The Government is failing to bring forward a coherent child care policy. When we see what the rest of Europe is doing in the area of child care, it is evident that Ireland is hardly in the ha’penny place. The average cost of child care to Irish couples represents 20% of income, compared to a European average of 12%. In addition, we have one of the worst parental leave regimes in Europe, so it is laughable that the Government amendment should refer to “the provision of enhanced arrangements for parental leave”.
A few weeks ago, this House passed a Bill that increased the parental leave provision so that one now has 14 weeks of unpaid parental leave until a child is eight years old. That is considered to be a major extension but is, in fact, minimal. During that debate, it was clear from the remarks of the Minister of State, Deputy Fahey, that the Government has no intention of further enhancing parental leave arrangements. Therefore, people who are considering having children in future should be aware that they are living in a country that has the least favourable unpaid parental leave arrangements in Europe. That is another pressure point for parents because raising children is an expensive option.
Last Friday, the Minister announced additional funding for the equal opportunities child care programme. While the programme is welcome, it is coming from a position of little or nothing. A considerable amount of public money is being spent on the programme but we must look at it in context. It is developing a child care network through the county child care committees which are doing excellent work but they are only just starting and the necessary financial provision is only beginning to emerge.
While capital grants are welcome, they are also essential. Last week, the Minister announced capital grant assistance of €800,000 for a facility at Upper Church, as well over €1 million for St. Sheelin’s, Templemore. That is all very welcome but let us be clear that nothing would be happening if it were not for this capital grant assistance. While that assistance is excellent, the main issue concerns staffing grants. I look forward to hearing the Minister’s response on this key issue.
I refer specifically to the departmental letter of November 2004 to child care facilities concerning the review of staffing grant assistance that is being carried out in the Department. I have spoken to people who are running child care facilities not only in my own area of north Tipperary but also in other regions, including areas of severe disadvantage in Dublin such as Tallaght. Such people tell me that if their staffing grant assistance is cut this year they simply will not be able to function. The Minister may be aware that in Tallaght a brand new facility is almost finished but the people who are due to move into it say the staffing grant is insufficient. They cannot manage the facility without a commitment to ongoing increased assistance. One must remember that many of these facilities operate with people on community employment schemes. They are dependent on such schemes to maintain a level of staffing adequate to meet the needs of the children in those facilities. I have no problem with this in principle. From my experience, excellent people have emerged through the training and opportunities they received through community employment schemes.
However, this is not good enough, with which point the Government’s own centre for early education and development in Drumcondra will agree. It is not good enough to rely on community employment schemes to maintain high-quality staffing in these usually publicly-owned facilities. It would be a good add-on and give good opportunities to individuals in particular but it is not good enough that these facilities rely on community employment workers to continue in operation.
In the context of the equal opportunities child care programme, the staffing grant issue must be addressed. In particular, the areas of disadvantage must be given an assurance, which I ask the Minister to examine carefully, for ongoing committed funding, rather than having to rely on a hand-to-mouth existence and wonder what will be the position on 31 August next.
Roscrea 2000 is an excellent ADM-funded child care programme which supports parents in training and those in employment. However, if the staffing grant is removed, the organisation will not be able to subsidise such places, which are mostly allocated to lone parents and a number of people on low incomes. The Government must recognise the need for an ongoing commitment to funding in this regard. Otherwise, it points up a lack of commitment to using child care as a very effective way of tackling disadvantage. Evidence from the US and Britain shows that investment in pre-school education and early learning from infanthood, and supporting parents and poor families in particular through the provision of quality affordable child care in the community, is the most effective way of breaking the cycle of poverty, exclusion and disadvantage.
If the Government is really interested in doing this, it will be measured by the level of investment in these child care facilities. It cannot expect lone parents, poorly-paid families and people who are trying to get back to work to do so without support for their child care costs. Otherwise they will have no hope of breaking out of the cycle in which they are trapped. Our words mean nothing if we do not put our money where our mouths are. I look forward to the Minister’s reply.
Mr. D. McDowell: It is my pleasure to second the motion before the House in the name of the Labour Party Senators. The Minister of State, Deputy Fahey, spoke in a similar type debate in this House some weeks ago. He gave us a comprehensive description of the Government’s policy which also entailed a description of the current problem. He estimated that we needed approximately 220,000 child care places. He freely acknowledged that the current EOCP was providing approximately 30,000 places, of which three quarters had been provided up to June of last year. The Minister will, therefore, not have a problem with my stating that we have a major difficulty in terms of the supply of places and their related cost. This is having an effect on the lifestyles of individuals, has serious labour market effects, which we can explore at some lengths, and has a particularly intense effect on particular categories of people, especially lone parents.
It is interesting to examine the participation by women in the labour market in the past ten years. In a relatively short time, we have come from a position in which our participation rates were much lower than the European average to a position in which, for most age groups of women, the participation rates are approximately equal to the European average. However, there is one single and striking exception which is the case of women who have had two or more children. There is a dramatic and almost immediate fall-off in the participation rates in the labour market in Ireland of women who fall into that category.
The single clearest reason for this fact is the absence of affordable child care. We all acknowledge that we need more workers, which requires more migrant workers coming into Ireland. However, surely the minimum we should do is encourage and facilitate Irish workers, most of them women, who want to remain in the workforce to do so. They should be offered an active choice rather than obliging them to stay at home because of economic necessity.
There are two sides to the problem of child care in Ireland, namely, demand and supply. On the demand side, the Government’s response has just one string to its bow, namely, child benefit. As my colleague, Senator O’Meara has stated, the increase in child benefit in recent years is one which has had all-party support and is self-evidently a good thing. However, it was never intended as a child care subsidy. Rather, it was intended as an aid to parents for all of the costs of bearing and rearing children. It was never intended to have a serious impact on the actual cost to parents of child care. Even though the increase has been substantial, the Government cannot come anywhere close to compensating people for the real costs of child care.
This brings me to a critical issue or principle, on which I express a more personal view than that of my party. Nevertheless, it is an issue we must grasp because we have spectacularly failed to do so in recent years. It must be the role of the State, in looking to compensate or assist people in paying for child care, to acknowledge that people who actually incur cost and who pay out money are in a different position from those for whom the opportunity cost is the major cost. In other words, people who pay out money are in a different position from those who choose to stay at home and look after their children.
I know this causes upset and that women who stay at home to look after their children feel that they are in some sense being undervalued if they receive less assistance or subvention from the State than those who actively go out to work. However, if we do not accept the practical reality that people who incur real, actual costs are in a different position from those who incur opportunity cost, we will never get to grips with this problem because the State is not in a position to provide an equal measure of subvention to people who decide to stay at home and those who actually incur costs.
If the State provided an equal measure of subvention, it would not come anywhere close to covering the cost of child care, which is the crux of the problem. My preferred option, and that of my party, is where the State gets into direct provision. However, the State is not doing this. The equal opportunities programme has had the same type of approach as that which we have taken on so many other issues. The State would prefer that people sort this issue out for themselves, either in the informal sector or pay well over the odds if they can afford to do so. The Government then looks to plug the gaps. For example, it will assist the community and voluntary sectors to set up child care committees and so on in areas in which there is a need which cannot otherwise be met by the market.
Typically this leads to a messy multi-tiered system, as is the case in so many other areas in Ireland such as primary care centres, legal aid and so on. Therefore, one finds oneself trying to create a false equality between various sectors when we have created an inequality from the start. My preference, and that of my party, is for the State to acknowledge that it has a responsibility to make direct provision, whether it is through using school facilities or constructing and subventing existing facilities. The voluntary sector will not cut it because this will lead to inequality. It relies in terms of the initiative on the voluntary sector itself. The Government states that if a group has a good plan, it will happily subvent it. I readily acknowledge that the EOCP has been good in subventing and assisting people with plans and initiative. Unfortunately, however, it is so often the case that the areas of greatest disadvantage and need, where the children need assistance and child care most, are the areas in which the gaps arise, not by accident but by virtue of social circumstances. Even now, we need to extend State provision by way of direct provision.
In terms of costs, there is a range of options. I am willing to consider possibilities which I would have been reluctant to consider some years ago. While not speaking for my party, there is some merit, for example, in the notion of a voucher system, in which people are provided with an entitlement to buy a certain amount of child care facilities. There is merit in this because it ensures the provision goes towards reducing the cost of child care and does not get lost in a family budget. However, I acknowledge that for it to work would require not only quality control but cost control.
I appreciate that I have just thrown out a couple of not very well linked ideas but this is an issue regarding which the Government has singularly failed in recent years. It has done so not simply because it has failed to deliver but because what it was trying to do in the first place was not adequate. I second the motion on behalf of the Labour Party.
Acting Chairman (Mr. Cummins): A correction must be made to the text of amendment No. 1. The reference to €1.9 million should be €1.9 billion.
Mr. Kett: I move amendment No. 1:
—the considerable progress which has been made in increasing the availability of quality and affordable child care places across the country through the equal opportunities child care programme and other Government initiatives;
—the provision of an additional 36,500 new child care places, as a result of funding allocated to date under the equal opportunities child care programme;
—the very significant increase in child benefit which is available to all parents of children under 16, and children under 19 if they are in full-time education, which affords choices to parents in relation to the care of their children;
—the fourfold increase since 1997 in child benefit expenditure, from €506 million to over €1.9 billion;
—the staffing grant assistance which is provided under the equal opportunities child care programme which aims to ensure that these grants target community-based not-for-profit groups which serve families who are disadvantaged;
and endorses this Government’s ongoing commitment to
—the development of quality affordable child care to support parents in employment, education and training through the equal opportunities child care programme;
—the provision of considerable current funding support towards the staffing costs of child care services which support disadvantaged parents;
—the provision of early education opportunities for disadvantaged children through the Early Start and other initiatives under the direction of the Minister for Education and Science;
—the provision of enhanced arrangements for parental leave;
—the development of quality early education opportunities for children; and
—the use of child benefit as the most equitable way of giving support to parents towards the cost of rearing and caring for their children, irrespective of the family’s employment status.”
Minister for Justice, Equality and Law Reform (Mr. M. McDowell): I welcome the opportunity to speak to the amendment. I utterly refute the implication of the Labour Party motion and welcome the opportunity to put on record the achievements of the Government in the development of quality child care and the support of families since it first came into office in 1997.
Senator O’Meara inadvertently spoke the truest words we will hear in this debate when she stated the Government’s programme was coming from nothing, which is true. However, who was in Government when nothing was happening? It was Fine Gael and the Labour Party.
Ms O’Meara: The Minister should spare us. He can do better than that.
Mr. M. McDowell: There is no point heckling. I listened politely to the Senator. She should listen to the facts, which are that nothing was done when the socialists were in power.
Ms Terry: I thought the socialists were still in power.
Mr. J. Phelan: The socialists are in charge.
Mr. M. McDowell: From 1992 to 1997, no delivery or provision whatsoever was made in this area. It was a big black hole which the great social reformers failed to consider for one second. Now, Senator Derek McDowell in a de haut en bas tone states that the Government has failed in recent years. He should look in the mirror. Nothing was done when the Opposition had the opportunity. Now, Opposition Members complain about those who are doing something because it is not enough. This is good politics but very bad history.
Ms O’Meara: Can we have the real debate now?
Mr. M. McDowell: When Fianna Fáil and the Progressive Democrats entered Government in 1997, its first act was to establish the expert working group on child care. Its extensive report was the basis of the National Development Plan 2000-2006, which I am determined to implement and, more than that, surpass while I have ministerial responsibility in this matter.
The equal opportunities child care programme has an economic focus and a social inclusion focus. It helps to make available, at local level, centre-based child care at either break-even cost or subsidised cost, depending on family circumstances, to support the significantly increased numbers of women now in the labour market. Another amazing aspect of the success of the Government is that hundreds of thousands of women have been enabled to join the labour market in circumstances that did not apply in the past.
Ms Terry: They are forced to work.
Ms White: That is not correct.
Mr. M. McDowell: I do not believe anybody is forced to work. I will come back to this point presently.
Ms Terry: The cost of mortgages forces them to work.
Ms White: It is a choice.
Ms Terry: It is not a choice for many women.
Acting Chairman: No interruptions, please. The Minister has the floor.
Ms White: I am surprised at Senator Terry. That opinion is very Fine Gael.
Ms Terry: Senator White agrees with it. I have heard her say she would like more women to be at home.
Acting Chairman: Let the Minister speak without interruption, please.
Mr. M. McDowell: When the parties opposite were in office, there was such crippling taxation on ordinary families that the complaint was that there was no point in two spouses working because the State took everything off the poor spouse who joined the labour market and it was not worth his or her while. The situation has changed dramatically.
The Government originally made available €317.4 million, including €177 million in European Regional Development Fund and European Social Fund support, for the development of quality child care under the equal opportunities child care programme for the period of the present national development plan. Such has been the immediacy of the Government’s response to the pressures to increase that funding that the amount set aside in the national development plan for the equal opportunities child care programme in this period has increased from €317 million to €499.3 million, an increase of 57% from the original allocation. In addition, the Government has made a firm commitment to provide ongoing funding following the conclusion of the national development plan.
The programme aimed originally to increase the number of centre-based child care places by 28,300, or 50%, by the end of the programme period. Funding allocated to date will lead to the creation of 36,500 new places and, most important, of these, 20,500 were already in place by June 2004, two years into the plan. These new places are located throughout the country, with a significant number in areas of urban and rural disadvantage and they serve to make centre-based child care services available at local level.
Last Friday, as Senator O’Meara acknowledged at the time in slightly less charitable tones than in this debate, I announced a major allocation of capital funding because my colleague, the Minister for Finance, Deputy Cowen, had made additional capital funding available to me in budget 2005. This brings to over €67 million the amount of large scale capital for community-based projects which I have announced to benefit over 70 capital projects since budget day last December.
The success of the equal opportunities child care programme is a testament to the work of the many community-based not-for-profit groups and private child care providers who responded to the State’s invitation to develop quality child care services to meet local need. I expect to announce many further capital grants during this year to continue to build upon the dynamism of the community-based sector. In managing such a major investment programme, some delays are inevitable as projects must be subjected to thorough appraisal. It is also essential to manage appropriately the financial flows of Exchequer and EU funding.
I wish to deal with the issue of child benefit. To help all parents the Government parties in 1997, as part of their child care strategy, considered a number of strategic options. It was not a matter on which there was party division but there was a vigorous debate within Government as to which option was fairer or more socially just. One option was to put all the eggs in one basket and have a series of Government subsidies through the taxation system. However, this would not avail those not paying tax and, because of the tax reform policies of the parties in Government, the tax bills of many families are very low. The alternative view was to put the money directly into the pockets of families through child benefit.
I will repeat again, because it was worthwhile when we were dealing with the Labour Party motion, what has happened with regard to child benefit. Overall expenditure on child benefit has increased almost four times, from €506 million in 1997 to an estimated €1.916 billion, just short of €2 billion, in 2005. During this time, the minimum monthly rate per child has risen dramatically from €36.83, the rate which we inherited from the socially enlightened parties in this House, to €141.60 next month in 2005, a rise of 272%. When those who talk about supporting families with children had the opportunity — and God knows they lecture us about what a wonderful economy they handed over in 1997, how competent they were, how the place was booming, how everything was going swingingly — in 1997 they were giving some children child benefit of €36.83, or the equivalent of that, which is about €9 weekly.
These unprecedented increases make a significant contribution to all parents, not just those in employment, or those who choose centre-based child care. Income tax credits, on the other hand, would naturally only benefit those who pay income tax. Given the progress achieved by this Government in taking low-wage earners out of the tax net, tax credits would be of little or no benefit to the low paid, forgetting altogether about the unemployed. Refundable tax credits, as proposed by the Labour Party motion, would similarly be of no benefit to those parents whose child care needs are met by family members, or through other informal arrangements.
That is not to say that the tax system does not provide reliefs which help taxpaying parents. The Government provides relief through benefit-in-kind taxation, where employees have child care provided to them at a subsidised rate by their employers. In addition, the tax system treats many parents with dependent children very favourably through the one-parent family tax credit, the widowed parent tax credit, the incapacitated child tax credit and the home carer tax credit.
Individualisation was introduced to help those families and alleviate the tax burden on families where both parents went out to work. Such matters are forgotten about because individualisation got the attribute of being a bad thing even though the Irish Congress of Trade Unions had supported it vigorously up to the moment when it was introduced and it then abandoned it, at least as far as public debate was concerned.
The Government also fosters the development of private child care services through tax incentives available to investors and service providers. In other words, the tax system is being used. The Government has continued to develop early education to support disadvantaged children in their early years. The Early Start project has been established in 40 primary schools in designated areas of urban disadvantage in Dublin, Cork, Limerick, Waterford, Galway, Drogheda and Dundalk, making a total of 1,680 places in those centres available to give children from these areas special supports to prepare them for primary education.
I am the first to admit that we could and must do a lot more. I make no pretence otherwise. I admit that during the next general election the child care issue will be one of the battlegrounds on which the election is fought. I have no doubt about that. However, I ask people that when election time comes, and it will be some time yet as far as I can see, they remember who did something and who did nothing in this area. They should attach some credibility to the achievements of those who delivered, even coming from nothing, to use Senator O’Meara’s phrase, compared to those who presided over nothing and did nothing in the area. Let us remember that fact.
There is a significant issue of supply to be considered by the body politic and I will be interested to see contending theories developing over the next while. Voucher systems, as canvassed admittedly in a sketchy way by Senator Derek McDowell, could, on their own, if there were no increase in supply, massively increase the cost of child care and be of very little incremental value in terms of social advancement.
There are other ways of looking at increasing child care. If I can, in the same sketchy way as did Senator McDowell, put forward one area where there must be political debate and a careful examination. There are many people who would supply child care services in an informal setting if we were to extend to them the same kind of taxation treatment as we did in income disregard for people who, for example, take lodgers into their homes. Currently, many people accommodate lodgers on an income disregard system because that was seen as one way of increasing supply of accommodation, of sharing it out and encouraging people to do so. If we are serious about increasing the supply of child care, an income disregard system would be well worth considering for those who would be in a position to supply it if it were not for the fact that they would lose social welfare entitlements or be heavily taxed.
I am not excluding the notion that in the future we might go down the road of special taxation treatment for child care expenditure but in that regard, two things must be borne in mind. Unless that system were run in a totally fair way it would tend to benefit the haves rather than the have nots. It may also have the effect of increasing the cost rather than the supply of child care places. We must, therefore, be careful of unintended consequences.
We are a society that has moved from nothing to something and we are implementing, ahead of target, a very worthwhile equal opportunity child care programme. Second, for the reasons I gave earlier, it is not true to say that the taxation system does not assist child care. Third, if as a society we are to commit further resources to the subsidy of child care we must be careful that the way in which we do that does not simply drive up its cost and not increase its supply. Measures directed at the creation of additional capacity are of more interest in the long term to most parents than measures which simply give them the illusion of getting some State help if the effect of that State scheme is to run up prices yet again with capacity not expanding to meet the demand.
I agree that many parents feel that the current burden of child care is a significant budgetary item. Anyone who disputed that would be living on another planet. What we need now are creative solutions to the problem, not old, hackneyed thinking taken down from the shelf. We will have a general election in two years’ time and this will be a central issue. Proposals put before the electorate cannot be gimmicks. We cannot do what my good friend Garret FitzGerald once did, namely, propose that £9.60 be taken from the husband’s wage packet and given to the wife. We cannot have solutions that rob Peter to pay Paul. We cannot introduce inflationary subsidies for child care which put it outside the reach of those least able to afford it and play into the hands of those who can most afford it. We must have a system based on the notion of increasing the supply of child care of adequate quality.
I am not suggesting that we have yellow pack child care or that we should have houses used as holding pens for children at cut-rate prices. Child care is hugely important in a child’s potential development and its quality is all-important. In terms of equality, tackling disadvantage depends on delivering high quality child care.
I ask the House to adopt the Government amendment as it views matters in a fairer light. I also ask the House to note that Senator O’Meara’s comment that this Government was “coming from nothing” says more about the party she represents than the Government of which I am part.
Ms Terry: I welcome the Minister to the House. I wish to share two minutes of my time with Senator John Phelan.
Acting Chairman: Is that agreed? Agreed.
Ms Terry: I agree with the Minister that child care is a huge issue for working parents today and needs to be tackled. It is unfair of the Minister to pick on the observation made by Senator O’Meara that we are “coming from nothing”. We do not need to remind the Minister that times have changed. Many more women and mothers work today than did in 1997. Although there were difficulties in 1997, many child care providers who were in business in 1997 have been obliged to go out of business since, as I was myself. I used to run a playschool at one time but with increased regulation and other complications that arose, like many other women I left the business. Services were more affordable in those days and most of the children who came to my playgroup were from homes in which only one person worked. Cost was not then such a major issue. The issue now is that child care costs rather than supply have increased in the meantime. The Minister was unfair to pick up on the point.
Many more women are in the workforce today and Ireland is close to the EU average of 56%, an increase of 140% since 1971. The number of women in the workforce is expected to grow by 218,000 by 2011. We have a rapidly changing society with a well educated workforce in which women tend to be as well educated as men. Some women wish to continue working while others want to spend more time at home. In a recent survey of parents, 62% of mothers and 86% of fathers stated they wanted to spend more time at home with their children. In 1997, in many cases, both parents were not obliged to go out to work. Today, however, the cost of a mortgage for young families dictates that both parents must work and a very high percentage of their income is spent on child care. Anything up to 32%, and sometimes more, goes on child care costs. If one combines that with the cost of a mortgage, some people have little disposable income left over.
I wish to draw Members’ attention to some statistics from a report on the issue published by ICTU. It states that of approximately 500 respondents who took part in a survey, 25% had not applied for promotional opportunities because of child-minding responsibilities. Of those stating they had not applied for promotional opportunities for this reason, 90% were female. Other effects of child-minding responsibilities included leaving the labour force altogether for a period or moving out of an urban area due to child care costs.
All of us, probably the Minister included, accept that responsibility for child care still falls primarily on the mother. An increasing number of mothers avail of work practices that allow shorter working hours, be it flexi-time, shift work or job-sharing. As this survey demonstrated, mothers tend not to apply for promotional opportunities or leave the workforce altogether. There is a huge demand for supply. I do not agree with the Minister that child benefit is the best way to deal with child care costs. The money available in child care is very good. While the Government has failed in its promise concerning the amount of child care support that was to be paid out by 2005——
Mr. M. McDowell: That is not true.
Mr. J. Phelan: The Government has failed.
Ms Terry: Yes it has. However, the Minister for Social and Family Affairs, Deputy Brennan informed this House yesterday that the Government will live up to its promise next year. There is no way that child benefit will pay for child care costs. I favour tax credits as a way of extending assistance for child care costs to more people. For example, if one takes a round figure cost of €100 per week, it actually costs most people nearly €200 to pay for it when one takes income tax into account. The provision of tax credits is a reasonable way to alleviate child care costs or extend child care facilities to a greater number of people. A method should be established to ensure that those on low incomes or who are unemployed can be provided with affordable child care facilities. We are all aware that the children of lone parents can live in greater poverty than children of employed parents. Therefore, it is important that child care is provided in the locality from an early age for them.
Although the equal opportunities child care programme is providing additional places, a danger exists that the funding may run out. The national development plan only runs for five years. What will happen to these crèches then? Increasing the supply is the answer and this will also keep down costs.
Mr. J. Phelan: I agree with my colleague Senator Terry and support the Labour Party motion. A notion has crept into the debate that all couples where both partners are working do so voluntarily. This bears no resemblance to the truth. Many people with young children are forced to work because they have to pay huge mortgages. From time to time, the Government tries to wash its hands of the problem by saying that their decision to work is voluntary. However, this is not a voluntary decision for most families with young children and the Government should face up to that.
I am sure all Senators could outline different examples in their own constituencies of voluntary groups that have not received or are having difficulty receiving funding from the Department regarding the establishment of child care facilities. I can cite an example from Kells, a village which has undergone extensive development in the past few years, in my constituency in Kilkenny. A local voluntary committee in the village has raised €60,000 or €70,000 locally to establish a community resource centre, the main plank of which is to be a child care facility. In the past two or three years, all of the committee’s applications for funding from the Department of Justice, Equality and Law Reform for that child care facility have been refused. Yet before the end of 2004, it received a grant of €10,000 from the Department of Community, Rural and Gaeltacht Affairs to provide kitchen and other facilities in the new building when it is built. That money will have to be handed back in June 2005 because, yet again, the committee has failed in its attempt to get funding for the child care aspect of the resource centre. That example could be replicated in most parts of the country. We all know of community groups like the one I have cited. These people come together voluntarily, give their time and see their efforts strangled mainly by an over-bureaucratic approach by the Department. Certainly, decisions are not properly explained. In many places, these groups end up dissolving in failure because of the obstacles they face. The attitude the Government has adopted here tonight is one that does not bear any resemblance to the situation on the ground. I would urge that a new approach be adopted by the Government.
Mr. Kett: I welcome the Minister to the House. I wonder why we are again having this debate, having debated the issue two weeks ago. Having the debate again diminishes what has gone before because we had a very constructive debate previously.
Ms White: Playing politics.
Mr. Kett: On that occasion, the Minister showed a great willingness to take on board the points of view expressed. I am at a loss because the Labour party has many good issues that it would wish to bring to the House during Private Members’ business.
Ms O’Meara: This issue is a priority for us.
Mr. Kett: Will this issue be a priority every fortnight?
Ms O’Meara: It is a priority now.
Mr. Kett: The Minister took up the point that we were coming from nothing and it reminded me of someone stopping to ask another person for instructions and that person saying to him or her “Well, I wouldn’t start from here”. It is necessary to start somewhere when dealing with something as important as this issue. This debate at least gives us the opportunity to congratulate the Minister on the additional €32.5 million he announced would be provided in child care grants since we last spoke on the issue. That announcement gives effect to the commitment given by the Minister of State at the Department of Justice, Equality and Law Reform, Deputy Frank Fahey. We are also to have an increase of 2,500 places, which brings the total to 36,500. The equal opportunities child care programme committed itself to having 28,000 places by 2006. We have surpassed that figure and, as the Minister said, more than 21,000 of those were in place by 2004. While this may be the result of the equal opportunities child care programme, it was a programme that was agreed by both the Government and Europe. Even since the programme’s inception, we have increased our commitment from €318 million to approximately €500 million and that will continue to the end of 2006. The Minister also stated before and again this evening that he intends to continue to support this endeavour after the current envelope of money runs out. I welcome his commitment.
There has been massive social and economic change in Ireland in the past 30 years. It was only in the mid-1970s that women began to remain in the workforce after marriage. The majority of them would have left the workforce after the birth of their first child. Only those women who were fortunate enough to have family members or neighbours to mind their children could remain in the workplace in those days. As the Minister said, we need to put in place a pre-education network where children are stimulated prior to going to school rather than dumped in day care. Children need stimulation in some kind of preschool setting. One speaker said that it is estimated that up to 220,000 children need pre-school education at any given time. We know now that more women are going back to work for a variety of reasons — training, education, etc.— which is also bringing about increased demand in this area. It is incumbent on us to make it possible for these women and these families to have choices because they women have contributed in no small way to the current economic situation. We all want these women to be able to continue in work so that the economy can continue to flourish.
Ms Terry: What about fathers?
Mr. Kett: We have had the opportunity to work, now it is the mothers’ turn. Despite the investment and successes of the EOCP, there is no doubt we still have a long way to go in the challenges that face both the development of child care and child care itself. The EU, under the Barcelona Summit, requires us to reach a specific ratio of child care places by the end of 2010. These targets differentiate between the younger child, in respect of whom there should be one place for every three children by 2010, and children requiring early education. Regarding early education, we must provide for 90% of children between the ages of three and the statutory schoolgoing age. I was struck when I read the document on the equal opportunities child care programme 2000-06 by the number of women who are now working as opposed to the number of women who were working in 1997. The figure has increased by 32%, from 588,707.
Ms Terry: That proves Senator O’Meara’s point.
Mr. Kett: It means that women are managing to go to work; they are not trapped at home because of this terrible Government. The number of women in full-time employment has increased by 32% and the number of women in part-time employment has increased by 33%. Women are making a massive contribution and childminding facilities are available. I accept there are too few of these facilities and perhaps they are not the right type in many cases. The document interestingly suggested that the total number of women who considered themselves underemployed had declined from 13,000 in 1997 to 1,900 in 2002. That suggests that maybe more women are leaning towards part-time employment. One can be in no doubt about this if the financial aspects are considered. I examined this issue with a young lady who has left full-time employment for part-time employment. She told me her joint salary with her husband fell by €300 by virtue of going half-time but that her child care costs were reduced from €1,100 to €730. This constitutes a net gain of €70 and carries with it the benefit of an additional two and a half days with her child per week. A part-time scenario can be equally as beneficial to women. I welcome the manner in which the Government is addressing this issue and I acknowledge Senator O’Meara’s statement on how far there is left to go. However, we are going in the right direction.
Mr. Quinn: I welcome the Minister. I cannot agree with Senator Kett that this issue should not have been raised again so soon after the previous discussion on it because I have learned something today. For instance, the Minister told us that the problem is not solved by pumping more money into this if the supply and demand situation is such that the price goes up. I also learned that child benefit is the most equitable way of giving support to parents. These are interesting debates but I cannot agree with the Minister for the same reason put forward by Senator Kett in his criticism of Senator O’Meara’s statement on the situation in 1997. The demand that exists today did not exist in 1997. In less than a decade the social structure of the country has changed, a change to which we have not yet adapted. I welcome the debate because an effort is being made.
One means of adapting is by providing universal child care. In France, where working mothers have been the norm for generations, we can get a taste of how we could adapt. Any French person looking at Ireland would find it incredible that such a situation would be allowed to exist. Public schooling starts there at the age of two years and the first four years take place in what they call the maternelle. This is more of a kindergarten than a real school as we know it but regardless of whether they attend a maternelle or a school for older children, the youngsters are first delivered to a garderie. This is a childminding service that looks after children before and after school hours and also takes them to and from the school. As such, a parent can leave his or her child at the garderie on his or her way to work and collect the child on the way back in every commune. This could be as much as 12 hours later. It is a universal, low-cost service.
The challenge is putting this into operation in Ireland without supply and demand creating other problems, but it remains an example of how we should adapt now that working mothers have become the norm since 1997. Putting in place such a system would certainly be expensive but this is not a reason for refusing to bite the bullet. We have adopted one aspect of a new society while trying to escape from its inevitable consequences. The result is untold misery for parents and we can only guess what consequences there will be for their children in the future.
We need, therefore, a national child care system. More is required besides this, such as making it easier for mothers to reject the new norm if they so wish. Money is the key. Most working mothers of young children do not work by choice but have no other economic option, as we heard previously from Senator Terry. It should not be beyond the wit of our ingenious banks to devise a special parents’ mortgages scheme. This would allow house owners a special holiday period of up to ten years, for example, in which their mortgage payments would be drastically reduced if one of the parents was not working. The repayments would be rebalanced so that the house owner would pay more later, as I am not suggesting that the banks should do this out of charity. If the banks charged less in the case of a working mother who stopped working to look after her young children, the State could row in with a special tax allowance that would reduce her outgoings even further. Between the banks and the State, the financial position of young families could be transformed overnight.
Such an arrangement would not suit everyone, as not everybody is in the position of paying a mortgage. However, it would provide an option to many people who currently have no choice as to whether they go to work or stay at home to look after their young children. I urge that we look closely at creating this choice as a creative way of responding to the new situation we have created in our society. There was not a need for this seven or eight years ago but there is a need now. We must be innovative in our thinking and I propose this as an option for consideration. It would require a joint effort by the banks and the State and it would be good business rather than charity.
Before I became a Senator I was approached with the problem that when children are growing up is the time when young parents need money, yet the mortgage is at its highest then despite being spread over many years. They do not need the same amount of money when they enter their 50s and 60s but must not make the same mortgage repayments. The ideal way of addressing this is to rebalance the repayments, particularly if child care is taken into account. I urge the Government to consider this. May I share my time with Senator Norris?
Acting Chairman (Mr. Leyden): Is that agreed? Agreed.
Mr. Norris: I thank Senator Quinn for this opportunity to make a small contribution to this debate. I admire his handling of the subject because, unlike the tweedledum and tweedledee of the Government and the Opposition, he did not spend time in carping negative comments and tried to put forward a sensible and practical suggestion that addresses the real social situation. The House should always operate in this fashion. I find myself in a difficult situation because I would prefer to abstain on this issue and say “a pox on both your houses”. However, I must vote one way or the other.
Senator Quinn raised the subject of change. The moment I saw the figure of €800 per month I thought of how things have changed and the rocketing price of houses immediately came to mind. I agree with the Senator that the crippling burden of mortgages is something that is driving women who do not necessarily all want to work. I am in favour of choice. Young women should have the choice to go out to work if they want but being a full-time mother is a reasonable, decent, professional and multifarious occupation. It is not right that people are squeezed in this way. The Government should listen carefully to Senator Quinn.
The motion and amendment reflect the way in society has radically changed. One issue I will raise again falls under the umbrella of securing child care and its enormous costs. Senator Maurice Hayes referred to an issue I raised on 8 March 2005 and I ask the Minister to examine the case of the four autistic children without prejudging it. Their parents have tried for a long time to get access to services for them. I know it is difficult. Four our five years ago I did battle in this House on an Adjournment matter regarding the parents of two autistic children who had access to some services, including speech therapy. These services were withdrawn because of a bureaucratic redrawing of boundaries and the parents had the awful and tragic experience of watching their children regressing. If autistic children are not constantly kept up to the mark, they tend to go backwards, particularly if they are at a certain stage of development. We fought to get something done in the past and Senator Ross has raised the issue of autistic children repeatedly.
This debate is extraordinary. Senator Maurice Hayes dealt with the matter in an economic setting, claiming that it would cost €500 to keep a child in care. I would have thought the figure to be €800 or €1,000. He made the point that if this money were given to the parents they could look after their children much better. The sequence of events worries me. I have personal experience of Ireland’s child care services, though not as a parent. In other circumstances I have been involved directly in regard to the welfare of children and their parents. I found the service providers to be caring, professional and competent. I have also found them to be arrogant, bullying and ignorant. They are more interested in their status than the welfare of the child. I have had direct experience of this.
I am bewildered. I do not know whether in this situation we are meeting the arrogant, bullying face or the caring, professional, competent face of the authorities. We, as legislators, should know which, because the sequence of events is so worrying. These parents dealt with the child care people for 18 months. They then went on radio to publicise their plight, as was their right. Within a matter of days their children had been taken from them. Within a week they had been required to undergo psychiatric assessment, despite the fact this had been done within the previous year and they had received a report saying they were perfectly all right. This is terribly worrying and we would be negligent if we did not draw it to the attention of the relevant Department and seek to ensure agreement, as framed in this motion by both sides of the House. Despite their spats, I believe both are interested in the welfare of the child.
I am glad to have had the opportunity to draw attention to this matter. I am not for one side or the other. I do not say these are dreadful, malign people, but suggest that the matter should be examined.
Mr. Minihan: I welcome the Minister of State, Deputy Tim O’Malley, to the House and welcome the opportunity to speak on this motion. No politician can be blind to the ever-growing demand for quality child care. If proof of the demand was needed, one need only have spent time on the doorsteps of Kildare North or Meath where this issue was raised many times in recent weeks.
The cost and availability of quality child care has become a major issue for many families. Often couples in search of affordable housing are forced to live many miles from their kith and kin and far from the traditional support structures that existed in the past. Those with large mortgages frequently delay starting a family because of the extra financial strain child care would put on them. The question for other couples is often whether one or both should change their work pattern to provide child care for the family.
By raising this issue, the Labour Party has, like any Opposition, rushed to oppose Government regardless of its achievements. The Labour Party has turned a blind eye to the achievements of the Government in the area of pre-school child care. The Government and its predecessor have made a greater commitment to the child care sector through the equal opportunities child care programme than any of their predecessors. The Government is committed to spending at least €499 million on this programme by 2007. Even then, investment in our children will not stop. The most recent budget brought a commitment from Government to a further increase in capital funding under the next phase of the equal opportunities child care programme which will start officially in 2007. The funding allocated to date has resulted in the creation of some 36,500 new child care places.
The Government’s commitment does not stop there. The equal opportunities child care programme aims to create quality child care places. The issue of quality is linked to training, education and professional development. In 2002 the national coordinating child care committee, established under the auspices of the Department of Justice, Equality and Law Reform, published the document A Model Framework for Education, Training and Professional Development in the Early Childhood Care and Education Sector. That document sets out clear guidelines for professional development through child care education and training. This document now forms a keystone in the thought process of the Department as it works to ensure the well being of all children in early childhood care and education.
The Government has done, and will continue to do, more than any of its predecessors. To argue otherwise is disingenuous. However, there is one area in which it must do better, namely, the provision of child care for school-age children. While the equal opportunities child care programme has been a boon for parents seeking facilities for pre-school children, those same parents are faced with a dilemma when their children start school. Unless they already have an established child minder, the prospects of finding child care for five years or more are slim. Faced with this problem, many parents, in particular women, are forced to put their careers on hold, perhaps for a period of ten or more years.
There are approximately 800,000 women in the workforce. They should be given every opportunity to develop their careers safe in the knowledge that their children’s care is provided for in an environment where stimulating leisure activities are the norm. The provision of these activities, whether before or after school or during the holidays, is vital to the success of any child care scheme for school-age children.
The Minister of State is probably familiar with an example of such a scheme, the Milford After-School Facility, Castletroy, County Limerick. This was built with the aid of a capital grant of €250,000 in 2002. It caters for 40 school-age children providing them with a range of classes and activities, including speech and drama, supervised homework, arts and crafts and French language lessons. While the facility is primarily used by the students and staff of the University of Limerick, with children attending the Milford national school, surplus places are available to parents of other children living in the area.
With over 3,000 primary and 750 secondary schools in the State, all of which are largely under utilised outside of normal school hours, we have the means to provide facilities for school-age children. All that is required is the will, which, unfortunately, is lacking in some quarters. In 2003, the national child care coordinating committee made a number of recommendations covering all aspects of school-age child care. A number of those recommendations directly addressed the issue of the use of school property. Unfortunately, the use of school premises is a matter for the patrons and the managing authorities of the schools. I understand that despite its best efforts, the Department of Justice, Equality and Law Reform has failed to engage the interests of the school management authorities. This is unfortunate as there are many benefits to be derived for local communities through the use of school premises as school-age child care facilities.
The future of child care here lies in the provision of high quality facilities that offer a development programme of activities. In addition, such facilities could help foster, for example, healthy eating habits through the provision of nutritious meals to the children in their care.
I commend the Minister and his staff on the work they have undertaken through the equal opportunities child care programme and urge them to redouble their efforts to persuade school management authorities of the benefits of participating in out of school hours child care. I support the Government amendment to this motion because it is a fairer representation of the situation and of how we should proceed.
Mr. McCarthy: This important debate has been given added impetus as a result of the forthcoming by-elections in Meath and Kildare North. Child care is one of the main issues debated on the doorsteps with politicians of all hues.
A number of comparisons have been made between the situation now and in 1997. This comparison does not compare like with like. Much has happened in the past eight years, not least that in budgetary terms we have a budgetary surplus of billions now whereas in 1997 it was just £15 million. The revenue and opportunity exist now to do something constructive and proactive in terms of child care.
In recent years we also had a largely unused resource in our economy, namely, the number of skilled and professional women not actively participating in the economy. Now these women are part of our economy and in no small way have led the drive and dynamic in this context. It is a major issue when the data available to us to make informed decisions are considered. RecruitIreland conducted a survey recently, which revealed one third of all parents expend between €600 and €900 a month on child care. That is a frightening figure, which is similar to the amount paid by young couples on mortgage repayments every month. The average price of a three bed semi-detached house is €320,000 and mortgage repayments for people who buy these houses is equal to child care payment. That demonstrates the extent of the child care problem. Irish women have more children than their European counterparts. However, child care facilities in Ireland lag well behind European countries. The Government has a poor record on the provision of child care places and the cost of available places is a significant issue.
The National and Economic Social Council’s draft report asserts that the average cost of sending a child to a crèche represents 20% of earnings, which demonstrates the difficulty faced by people meeting the cost of child care. Little has been done by in recent times. While I will not pre-empt the results of the upcoming by-elections, hopefully, an extrapolation of the results will lead the Government to seriously examine the issue and do something meaningful and proactive.
My party has done a great deal of research in this area, particularly through my colleague, Senator O’Meara, who ensured the issue is debated. Improvements should be made in a number of areas. For example, parental leave should be addressed because it is currently a token gesture. It should be meaningful and realistic and a system should be developed to afford both parents a period not exceeding 12 months to spend with their child during a constructive and important phase in their lives. Many developments to support employees have emanated from directives issued by Brussels. While that is not necessarily bad, we should be proactive in pursuing a strategy to benefit working parents rather than reacting to such directives. We are well aware of what child care facilities are not provided but the State must pursue a system that can provide child care at a reasonable cost. Senator Minihan proposed the use of schools when classes have been completed. The Labour Party supports the introduction of a tax refund so that families whose incomes are low can receive direct payments in lieu of a tax credit.
A number of issues need to be examined. While I welcome the debate, I hope action will be taken because recent analysis and opinion polls highlight that child care is the main issue exercising the minds of many people. It is not fair to compare 2005 with 1997 because economic activity, budget surpluses and child care demand are completely different. I hope the Government will take a proactive and positive lead on this issue as a result of the debate.
Ms Cox: While debating child care two weeks after a similar debate is welcome, and I am delighted Senator O’Meara tabled the motion, the sad aspect of Private Members’ motions is the issues become political footballs. It is important for us once and for all to say our children and the future of child care will not be a political football. Perhaps I am naive, foolish and stupid but looking after our children and the future of the country is the most important element of our jobs. It does not matter which side of the divide we are on because each of us has an equal responsibility to do our best in this area.
I regret the political point scoring earlier in the debate for that reason. I was sitting in my office and I will not repeat the words I uttered when I heard a number of the comments made. I was upset and annoyed. It is not fair to measure provision now against that a few years ago. This is a different era but a great deal has been done. The Minister of State is correct that child benefit has increased fourfold and quality services have been provided, including 20,000 new places with 16,000 under construction. However, a line needs to be drawn in the sand because a sea change has taken place in recent weeks following the publication of accounts of Cabinet discussions. If the information is emerging because of the by-elections, I am delighted.
We have been talking about this issue for the past number of years and are sick of listening to ourselves. However, Ministers are beginning to listen. It was interesting that the Minister for Social and Family Affairs acknowledged yesterday that child benefit was not the solution the Government thought it would be. Child benefit and the equal opportunities child care programme are fantastic but they are not solving the problem. This has been admitted and it is like attending AA and saying, “My name is Margaret Cox. I am a Fianna Fáil politician and we still have not solved child care”. That is a major relief and we can begin to do something.
Recently, the Minister of Justice, Equality and Law Reform mentioned payments to people looking after children in their homes and I can claim a little credit for raising this issue in the House. The payment for child care should be disregarded, as this gives recognition to the value of the work being done by the person looking after children in the home. Caring for children should be on a par with renting a room in terms of reliefs. I am delighted the ball is beginning to roll.
I am also delighted the Minister for Social and Family Affairs referred to the need for a two-tier child benefits system to address the child care needs of the disadvantaged while also recognising the universality of child benefit and the importance of not touching it. The cost of child care is a complex issue, which needs complex solutions. During the last debate on this issue, Senator Henry referred to child care provision in France while Senator Browne made a similar reference earlier. I am horrified at the prospect of putting my two year old on a bus to a large school to be looked after, no matter how nice are the carers. The French model is not the answer. A number of the issues may be addressed and an improvement would be wonderful. However, let us not reach a point where two and three year old children are put on buses to attend a nursery before taking up child care places. That is not the Ireland of 2005 and, if it is, I do not want it. I want to go home and forget about the Celtic tiger. I want to give my children the same upbringing all of us were lucky to have.
There are lessons to be learned from other countries but not every idea should be taken on board. Perhaps I might go back and put on the record of this House once again my view that parental leave is very beneficial, but it must be paid leave. We must put it on the agenda now. We can forget about it if we are not going to introduce paid leave in some form within the next two years, as it will be of no benefit to anyone.
We are also talking about solutions. People mentioned part-time work. I wish they would stop talking about “mothers” and start talking about “parents”. I am sick and tired of “the mothers”; I want it to be “the parents”. It is as much the father’s responsibility as that of the mother. We need part-time work, job sharing and incentives directed in particular at smaller organisations to facilitate their putting such options and incentives in place. We must acknowledge the difference it makes to families — mums and dads, whichever of them chooses to stay at home.
We cannot allow for periods of parental leave for one year without an economy that sustains it. Senator McCarthy is right that we may need it for a year for everyone, but we must have an economy that matches and provides for the cost. An economy that provides for such benefits or choices must be strong. For that to happen, we must protect the small and medium-sized businesses about which we talked. In the Small Firms Association magazine, Running Your Business, there is an article by Pat Delaney reviewing the last ten years. Perhaps I might quote one paragraph. It states:
I would also like to quote from another article from Equality News regarding a study carried out in four countries on the work-life balance of parents. It addresses the issue of creating a more favourable work environment. The article states:
That is our responsibility — the soft, fluffy stuff. There must be an overall, global approach from the Departments of Enterprise, Trade and Employment, Justice, Equality and Law Reform, Health and Children, and Education and Science.
Mr. Bannon: I too welcome the Minister to the House to debate the issue of child care. Being a parent and working are as compatible in this country as mixing oil with water. I would be the first to recognise that some progress has been made in the provision of funding for essential child care services. I was also delighted at the boost for such facilities in my own county of Longford. I was involved in achieving these improvements through Adjournment motions in this House and, privately, through dealing with officials in the Department from time to time.
Granard and Legan received this funding under the equal opportunities programme last week, and I acknowledge the professionalism of those dealing with the issue in the Minister’s office. I have an interest in the Legan child care committee, being a member of the board. I am also conscious of the plight of communities where no such help has been forthcoming. Before last week’s announcement, Longford had nine separate communities awaiting news of grant-aid for child care in their areas.
As I said, Granard and Legan received funding. However, the other seven areas are still waiting for funding to provide parents with the hope that both partners might be able to join the workforce. These areas are Edgeworthstown, Drumlish, Ballinamuck, Ballinalee, Killoe, Newtownforbes and Newtowncashel. In a cruel blow to their hopes, we now hear that there is a real threat that the Government may withdraw the staffing grant assistance which is currently provided under the equal opportunities child care programme to community-based, non-profit child care centres. That would be completely at odds with the stated objectives of the programme. I hope the Minister is here this evening to assure us that this is not the case. I ask him to imagine the consequences of such an action. Already scare facilities will be forced to close, and hard-pressed parents, struggling to manage the demands of work and home, will be faced with unrealistic choices.
The Taoiseach has been quoted as saying it is not the Government’s position to reduce or close child care places but rather to create more. Does that tie in with the threat of closing facilities? I do not think so. Such a serious issue should not become a political football or another broken promise. What could be just another cost-cutting measure for the Minister and his Department would be the end of lifestyle choices for many, not all of whom choose to work but are forced to do so by financial necessity.
The Taoiseach also said that child care costs €800 to €900 per month. We in the Opposition would not dispute that figure, but we object to the Government’s blatant attempt to ignore it and withdraw such necessary funding. I commend the excellent work done by so many in my area to provide low-cost child care for all. However, times are catching up with them, and costs are rising. Such changes jeopardise the continued provision of these facilities. For many people child care costs more than mortgage repayments, as pointed out by several Senators present this evening.
Providing tax credits for vouched child care is an obvious measure. It is imperative that the Government introduces tax credits for child care to go some way towards easing the burden and allow more women to enter the workforce. Such participation by women has been recommended in an OECD report on how richer countries can increase economic growth. The gap between the 30 developed economies of the OECD has widened, with output per person in the US now 30% higher than that in Germany and France. The differences will increase unless EU countries in particular improve their performance. If the image of parents chasing elusive and costly child care for their own financial ends does not persuade the Government to do everything in its power to extend child care places and facilities, the more persuasive argument of the economic growth of the country will stir it into action.
We all know that marginalised parents of school-going children would benefit greatly from the support of after-school services and that such services would allow them to avail of employment or educational opportunities that might otherwise not be available to them. Hard-working groups providing both full child care facilities and after-school care have shown unstinting care and dedication throughout the country over the years. It is now up to the Government to provide the funding. I am glad that two programmes of funding have been announced in the past three months. One hopes that more funding will be brought on board. As we know, in the BMW region, which I represent, there is a great underspend of funding in the area, something acknowledged in the BMW mid-term review. This issue must be examined by the Department to ensure that there is the necessary uptake.
On another issue, it was in the public domain for some time that the Minister would make an official announcement last Friday on successful applications but it was very disheartening to hear some Deputies make those announcements on radio one or two days before the official announcement. It happened in my county and in Wexford, Waterford and elsewhere. This showed great discourtesy to the Minister and his officials. The official announcement on funding was a non-event because those Deputies indicated what the Minister intended to announce on a particular day. That matter should be examined. We all talk about transparency, as does the Government, but I wonder if that happens all the time.
Ms Ormonde: I will not use up all the time available to me because I listened at length to the debate on the previous occasion. I welcome the Minister of State to the House and the opportunity to record my views on the motion. I thank the Senators opposite for giving Members on this side of the House——
Ms O’Meara: The Senator is very welcome.
Ms Ormonde: ——and the Government the opportunity to drive home the message that we are not reactive but proactive in our approach to this issue. The proof of that was contained in the Minister’s contribution. Those are facts. There are many schools of thought on this issue, even within the ranks of the Senators opposite, as to whether this should be approached by way of child benefit or tax credit. That question is asked even within our ranks. Nobody has the absolute approach, neither the Government nor the Opposition, and no one should take credit for this issue. As Senator Cox said earlier, no one should play politics with it because none of us wants that for our children.
Tonight we are discussing how best we can get quality child care at affordable cost. We may not have it yet but a welcome aspect of the Government’s policy is that it wants a community-oriented child care service, not the very large crèches where the children appear to be like robots. I might not have experience of child care but I know something about child development from a child psychologist’s point of view. There is nothing I dislike more than to see ten, 15 or 20 babies sitting in front of tutors who are giving them mass training in when to sit up and when to sit down instead of dealing with them one to one. I did not get that type child care when I was growing up but I think I did very well out of the care I received. We did not have this so-called marvellous tutor system to tell us what to do when we were one and two years of age.
Small is beautiful. We should have crèches with three or four properly trained adults in a house or in a community facility. I welcome the opportunity of providing training to people in the community who would love to get back into the system and take on that role.
For the past three weeks I have been out canvassing in the afternoons and I have never seen so many empty houses. I hate to think the future of Ireland will consist of factory oriented places with children in crèches and all the parents working. I realise that is the knock-on effect of the Celtic tiger but I worry about our future.
Mr. Bannon: Is the Senator worrying under Fianna Fáil?
Ms Ormonde: No. It is a knock-on effect of the Celtic tiger.
Ms White: The Celtic tigresses.
Ms Ormonde: It has been acknowledged that we want a community-oriented service and I welcome the fact that this was reflected in the Minister’s contribution this evening.
In terms of education, the Minister has also thought about co-ordination between the Departments of Education and Science and Justice, Equality and Law Reform because many young people would like to have this training in this area. We have the Early Start and Breaking the Cycle programmes. I would like to see these policies implemented but it is the children of six months to two years about whom I worry most. I would like to see some programmes introduced, and I am aware the Minister is thinking about this area in terms of flexi-time, allowing mothers to stay at home and providing a quality child care service in a community. Such an approach, which the Minister referred to it in his contribution, would be very welcome.
This is a golden opportunity to drive home the message that we should not play politics with this issue but consider how best to provide a quality child care service to the children of the future. That is what we should be talking about and we should be all singing the same tune. There are many in the other House who have a different opinion to those of Members who spoke here tonight but at the end of the day we must introduce what we believe is the best policy, and what the Minister said here this evening reflects that.
Ms White: I thank the Minister of State for coming to the House this evening. It is a pity the Minister, Deputy Michael McDowell, did not remain in the Chamber because as we all know the Department of Justice, Equality and Law Reform is the main driver of child care policy. I am not casting aspersions on the Minister of State but I would have preferred if the senior Minister had remained in the House for the debate. I do not want to be personal but if we were debating a legal or justice issue he would have remained.
Acting Chairman: Senator, the Minister, Deputy McDowell, was here earlier and made a contribution.
Ms White: I know. I have been here for the full debate.
Acting Chairman: I appreciate that.
Ms White: I am saying he did not remain for the full debate.
Acting Chairman: The Senator should continue.
Mr. Bannon: He is not here to hear Senator White’s contribution.
Ms White: He did not hear what the other Members had to say.
Mr. Bannon: The Senator’s contribution is very important and the senior Minister should be in the House to hear it.
Ms White: I am not being personal about the Minister but I am entitled to make my comments.
Acting Chairman: I have a responsibility too.
Ms White: The Department of Justice, Equality and Law Reform is the main driver of child care policy for the Government and it is important that the senior Minister is here for this debate. If we were debating a criminal, justice or legal issue he would have remained in the Chamber. My experience is that he remains in the Chamber for the full debate, and I have nothing against the Minister of State.
I admire Senator Terry. She revealed another string to her bow this evening when she said she was involved in child care. That is another of her assets. I am a great admirer of Senator Terry and I do not wish to be personal in making that remark.
I have occasional contretemps with Senator O’Meara but she was right to put this issue back on the agenda because it is currently the subject of major discussion. It was even discussed on the radio today. There is a feeling of helplessness among parents about the child care issue.
I have been studying the issue of child care for the past six months. In November I had the privilege of presenting to the Fianna Fáil parliamentary party, the Government party, my view on the state of child care in the country, and I got great support at the meeting. I could not say I got an ovation — I do not want to exaggerate — but I had been engaged in a detailed project for six months with other Fianna Fáil colleagues including Councillor Julia Carmichael, Dr. Orla McCarthy, a doctor of electronic engineering, and Niamh Cooper. We compiled this document together. We also met the Minister for Finance, Deputy Cowen. I am sure Senators will agree the report was a major bonus to the Fianna Fáil parliamentary party.
I hold in my hand a small sample of the studies that have been done on child care.
Mr. Bannon: Has the Senator passed details of them on to the Minister?
Ms White: The studies to which I refer are the national child care strategy, the national children’s strategy entitled Our Children — Their Lives, the national action plan against poverty and social exclusion implementation plan, the White Paper on Early Childhood Education — Ready to Learn — and the Department of Justice, Equality and Law Reform’s strategic statement. These are technical documents written by professionals involved in the area of child care. Last week, the OECD produced a report, Economic Policy Reforms: Going for Growth, in which the issue of child care in Ireland is examined. The Government has, therefore, been provided with a massive amount of documents and advice in respect of child care.
As part of my research, I visited crèches early in the morning when they were in the process of opening. Contrary to what Senator Ormonde stated, I was amazed by what I discovered. Perhaps I only visited the crème de la crème of these crèches but the children there receive wonderful intellectual stimulation and learn great social skills. I was an extremely shy person for many years.
Mr. Bannon: The Senator is still shy.
Ms White: Social skills are different to those one uses to support one’s opinion. Senator Terry — I hope she will support me on this — knows what I am talking about.
Ms Terry: The Senator is doing fine on her own.
Acting Chairman: Senator White, without interruption.
Ms White: The children learn great social skills by mixing with other children and receive intellectual stimulation. I saw children aged 18 months who are learning to paint.
I have first-hand experience of this matter from visiting crèches and meeting parents and those who own these crèches. I held a public meeting on 27 February in Baggot Street which was packed out. As this poster shows, I intend to hold a further meeting on Tuesday, 5 April in the Ringsend and Irishtown community centre.
Acting Chairman: It is not permitted to display advertisements, promotions or posters in the House.
Ms White: I apologise. I did not realise that was the case.
The meeting to which I refer is designed to help evolve my proposals on child care. Those proposals are not carved in stone because it is dangerous, in political terms, to carve anything in stone. I met people who informed me about the draconian regulations which have been set down and to which Senator Terry referred. These regulations are preventing people from entering the child care area. It is extremely expensive to run a crèche.
Myriad documents have been presented to Government in respect of this issue. In that context, there are 11 Departments which deal with child care and family issues. These include the Departments of Finance, the Taoiseach, Education and Science, Community, Rural and Gaeltacht Affairs and Justice, Equality and Law Reform. I wish to call for a co-ordinated Government approach on child care——
Mr. B. Hayes: Hear, hear.
Ms White: ——and the establishment of a Department of children and the family. The approach suggest would remove responsibility for child care and family issues from the 11 Departments to which I refer. The bottom line is that every child, rich or poor, born in this country should have an equal chance. During my research I discovered that the parents of economically disadvantaged children cannot afford to send them to the crèches I visited.
There has been only one successful co-ordinated approach taken by Government in recent years. I refer here to that initiated by Mr. Haughey in respect of the Irish Financial Services Centre. The Secretaries General of the various Departments were brought together in respect of that matter and made to co-operate with each other. We must establish should an approach under a Department of Children and the family and ensure that child care policy is child oriented.
Acting Chairman: I am obliged at this stage to call on Senator O’Meara to reply to the debate.
Ms White: I will conclude. Increasing child benefit is not the way to provide for people’s child care needs. One of the main points raised in the documents I listed earlier is that tax relief is one of the key instruments that should be used. The proposals I put forward do not exclude——
Ms Terry: It is a pity the Minister is not present to hear the Senator say that.
Ms White: Yes, I am disappointed that he is not here. The Department of Justice, Equality and Law Reform drives policy in this area and the Minister should be present.
Paying people €35.40 per week in the form of child benefit when a crèche place costs approximately €1,000 per month is not the way to proceed. Being obliged to pay €1,200 per month to place two children in child care is the equivalent of paying a mortgage of €240,000. In effect, people are paying second mortgages in respect of which they do not receive tax relief.
Acting Chairman: I thank Senator White for her contribution. By an order of the House, I am obliged to call Senator O’Meara.
Ms White: I thought the debate was to conclude at 7.15 p.m.
Acting Chairman: It is due to conclude at 7 p.m. In any event, the Senator’s time was exhausted. I call Senator O’Meara.
Ms O’Meara: I thank all Senators who contributed to the debate. I make no apologies for bringing forward this motion only two weeks after our debate on the equal opportunities child care programme to which the Leader was good enough to concede at my request.
Senators Terry, Cox, White and I have spoken about this matter on various occasions in recent years. However, we seem to have made a breakthrough in the debate. We and those involved in the child care industry believe we are finally being heard. In that regard, I wish to refer to those who work in that industry in the context of correspondence I received today. I understand that the Minister of State, Deputy Fahey, appeared on the recent “Prime Time” programme that dealt with the issue of child care. Unfortunately, he left viewers and those in the industry with the impression that he believes it is acceptable that child care employees should be on the minimum wage. That is indicative of how we regard child care. I hope the Minister of State will clarify his remarks. However, I also hope what he said will initiate a debate on how we should reward, in economic terms, those who carry out the important job of caring for our children. That is one of the myriad issues which need to be considered and tackled and brought to the forefront in terms of our policy agenda. The Labour Party is placing child care at the top of its list of priorities going forward.
As regards the comments of the Minister, Deputy Michael McDowell, I was being totally honest when I said that, in terms of Government spending on child care, it has been a case of our coming from nothing. Why is that the case? There are two main reasons. The first of these, as Senator McCarthy pointed out, is that the economic position in 1997 was very different to that which obtains now. At that time we were increasing child benefit by a substantial amount relative to the standards that then existed. We had a budget surplus of €15 million in 1996. That surplus is now counted in billions and the country is much changed.
The second reason relates to the fact that Ireland is now a different country. The latter is the case because, on foot of our economic prosperity, so many people are at work. That economic prosperity has created the demand for child care. It is not accident that every week without fail The Sunday Business Post comments on child care. It has become an economic issue and the Government must sit up and pay attention to it.
The participation of women in the workforce has been one of the drivers of our economic expansion.
Ms White: Hear, hear.
Ms O’Meara: In the past, women were an under-used resource in our economy. I am glad that they now have the choice as to whether they wish to be at work. Most women choose to be at work. We did not strive to be educated so well and then not use that education to some end. However, there are times in our lives, as mothers and parents, when we want to spend more time at home with our children. We do not want to leave small children, in particular, in someone else’s care for long hours each day or have very little time to see them. This is what generally happens to people who live in the commuter belts. That is their experience and it is no way to live in terms of quality of life, work balance and time management. Unlike Senator Ormonde, when I was canvassing in Kildare North I met many women who opted to go home to mind their children. They did this not only because of cost but because they also wanted to fulfil their desires and responsibilities as parents.
Senator Cox spoke about parental leave, paying for parental leave and how we need to be economically buoyant. Evidence shows that if paid parental leave existed, we would benefit economically as it keeps women in the workforce. If parental leave was paid for the first year of the child’s life, there is a far greater likelihood that women will return to the workforce. That has been shown in different studies. The Government will also benefit as the women who returns to the work force will continue to pay tax.
I agree with the Minister when he states that we have to be very careful about what we put in place in the next few years. We want to put measures in place which support families, communities and the economy. We have to be careful when we look at tax credits, taxation measures, vouchers and so on. They have an impact on those who are receiving the benefits and on industry.
The income disregard system has been part of our policy since 2002. One of the big advantages of that system for those who are in the informal network is that it brings them into the formal economy. It is also of great benefit to those who are running those facilities as they are recognised by the social welfare system and their hard work will be rewarded with a pension later in life.
I welcome this debate. It will not stop here as I believe we have only started. I am determined to keep this issue on the agenda, as are others in the House. We should ensure that it is a priority policy for every political party and I commend Senator White in her work in that respect. The only way to be heard is to demand to be heard. On this particular issue, it is extremely important to do so.
The Seanad divided: Tá, 24; Níl, 16.
|Brennan, Michael.||Cox, Margaret.|
|Daly, Brendan.||Dardis, John.|
|Dooley, Timmy.||Feeney, Geraldine.|
|Fitzgerald, Liam.||Glynn, Camillus.|
|Hanafin, John.||Kenneally, Brendan.|
|Kett, Tony.||Leyden, Terry.|
|Lydon, Donal J.||MacSharry, Marc.|
|Mansergh, Martin.||Minihan, John.|
|Mooney, Paschal C.||Moylan, Pat.|
|Ó Murchú, Labhrás.||O’Rourke, Mary.|
|Ormonde, Ann.||Scanlon, Eamon.|
|White, Mary M.||Wilson, Diarmuid.|
|Bannon, James.||Bradford, Paul.|
|Browne, Fergal.||Coonan, Noel.|
|Cummins, Maurice.||Feighan, Frank.|
|Finucane, Michael.||Hayes, Brian.|
|Henry, Mary.||McCarthy, Michael.|
|McDowell, Derek.||McHugh, Joe.|
|Norris, David.||O’Meara, Kathleen.|
|Ross, Shane.||Terry, Sheila.|
Tellers: Tá, Senators Minihan and Moylan; Níl, Senators McCarthy and O’Meara.
Amendment declared carried.
Motion, as amended, put and declared carried.
Question again proposed: “That the Bill be now read a Second Time.”
Mr. Bannon: The Tánaiste and Minister for Health and Children, Deputy Harney, is going around the country for photo opportunities which are worth nothing. The Minister would be better occupied in ensuring that help lines are fully manned. This matter has been raised by members of the public including the elderly who have complained in my clinics that help lines are mismanaged. Elderly people who dial a helpline number get confused because they must wait quite some time to receive guidance or obtain an appointment. It is extremely frustrating for them. The Minister should ensure that such services are properly constructed before establishing help lines.
The Minister has been pretending to open health services throughout the country. However, in the midlands in particular, there is evidence that facilities are promptly closed once she has left. Photo opportunities are only worthwhile if what has been promised is delivered upon. On this legislation and on other issues, I want to see action from the Minister, not false smiles. People want the Government to provide proper health services. Recent surveys have shown that health services have deteriorated since the Minister took office.
An Cathaoirleach: The Senator’s time is up.
Mr. Bannon: The closures may suit the Minister and may go some way towards shoring up the mismanagement of health service finances but they do not suit the general public. I am referring in particular to the people of the midlands, as the Leader of the House is well aware.
An Cathaoirleach: The Senator will have to conclude because other Senators are offering.
Mr. Bannon: I did not think my two minutes had elapsed.
An Cathaoirleach: I have been very generous to the Senator who has spoken for more than two minutes. I call Senator Leyden who has ten minutes.
Mr. Leyden: I may not avail of the full ten minutes, a Chathaoirligh, because so much has been said about this issue. Now is the time for action more than words.
Mr. Bannon: Hear, hear.
Mr. Leyden: Nevertheless, I welcome the Bill which is belated; part of the legislation has been overdue since 1976. I welcome the extension of doctor-only medical cards which is an innovative move by the Minister. It will allay the fears of many people who are deeply concerned about the cost of attending a general practitioner. Eligibility for the new card will be based on the current limit plus 25% or 30%, depending on the number of people coming into the system. Approximately 200,000 people would be eligible for this medical card, which is to be warmly welcomed, although most people would prefer the full general medical card, which has been of great benefit to so many families. I strongly recommend that the means test attached such medical cards is considerably increased because it has not kept pace with the cost of living. I have brought many such cases to the attention of the health boards over the years.
The Travers report which was published today will be debated tomorrow. Therefore, I do not intend to go into detail on it at this stage given that there are many aspects to it. However, in summary, the question posed was whether a person with a medical card had full or partial eligibility under the 1976 regulations. This was the crunch issue. I have been aware over the years that health boards withdrew medical cards from residents of welfare homes under their jurisdiction on the basis that they were being well cared for there both medically and physically.
Moreover, all the patients whom I visited in public welfare homes in the Western Health Board area when I was chairman of it were cared for in the most diligent manner by the staff of those institutions. The level of service was far higher than anything which could be provided in the private sector because of the staffing situation. A number of these patients feel aggrieved that demands for refunds might be made by relatives of theirs who might not have visited with them. Nevertheless, that is the law because the Supreme Court has made a decision in this regard.
The State must repay the money, particularly to the people concerned, with a heart and a half rather than half-heartedly. It should not pay the money grudgingly. Last week I was in contact with the Health Service Executive on a number of occasions, the telephone numbers for which, for the information of Senators Bannon and Finucane, are very easy on which to get through. I received an assurance that the application form would be redesigned, which point I raised last week with the Leader. The form which was provided referred to “a client” or “on behalf of” an applicant, whereas, quite a number of residents are eligible to apply themselves, a point they made clear to me when I met some of them at the weekend. They are applying directly to the executive for a refund of the money.
Mr. Bannon: This issue has been mismanaged and has caused a great deal of confusion to the public. Does the Senator agree with me?
Mr. Leyden: The people concerned are themselves seeking refunds of payments taken over a number of years. The money will be placed in their accounts. We must bear in mind that dormant accounts are held by the health boards on behalf of thousands of patients whose estates had a question mark over them in respect of the identity of the rightful claimants. Much of this money will be paid into these estates because many of the patients will not be physically able to spend the money which is being returned to them.
When I was chairman of the Western Health Board, I made the point that there is not enough activity for patients of public nursing homes. A system should be put in place so that those who are active are allowed to have an annual holiday to get away from the institution. The health board has buildings on the west coast in Connemara and Clifden which could be made available for a two week period. It is simple to organise such a trip and one would not need too much money to pay for it. I hope that some of the money which is returned will assist these people in enjoying the remaining years of their lives in care.
There has been a cynical exploitation of this issue by certain lawyers advertising on radio, particularly on Shannonside Radio.
Mr. Bannon: The Senator should name and shame them.
Mr. Leyden: I have heard two companies from Athlone which I have no difficulty in——
An Cathaoirleach: The Senator should not be provoked into naming anyone by Senator Bannon.
Mr. Leyden: I know the Cathaoirleach would not permit me to play the tape recording from Shannonside Radio and I would not dream of doing so.
Mr. Bannon: The Senator is keeping us up to date with the local news.
Mr. Leyden: However, the tape contains the name of two companies in Athlone which are asking people to come to them to apply for something for which they are eligible to apply for themselves — they do not need a lawyer. Furthermore, there has been exploitation by certain Fine Gael public representatives in Longford-Roscommon who have called a public information meeting on illegal charges on 21 March. An advertisement for the meeting in the local paper urges people to log their claim and promises details on the illegal charges imposed on persons in long-term nursing care between 1976 and 2004. All the details are published and this behaviour is exploitation of this issue. The public is entitled to apply through their public representatives.
Mr. Bannon: There is no proper system in place.
Mr. Leyden: It is not a question of competition between one Fine Gael Deputy or Senator and another.
Mr. Bannon: Name the Senator.
An Cathaoirleach: Senator Leyden, without interruption.
Mr. Bannon: On a point of order, the Senator referred to one Senator in the constituency of Longford-Roscommon.
Mr. Leyden: I did not refer to Longford-Roscommon at all.
An Cathaoirleach: That is not a procedural point. If memory serves me, the Senator did not mention any particular area. He mentioned a Senator. Senator Leyden without interruption.
Mr. Leyden: Apparently this great meeting is taking place and, according to the newspaper, a “John Kerry” will appear, who I presume refers to Deputy Perry, the former chairman of the Committee of Public Accounts.
An Cathaoirleach: The Senator should not mention the names of persons outside the House.
Mr. Leyden: There is a typographical error in the notice. It means to refer to Deputy John Perry not John Kerry.
An Cathaoirleach: Deputy Perry is not a Member of this House.
Mr. Leyden: Not yet.
An Cathaoirleach: The Senator knows that point well.
Mr. Leyden: I was a Member of the Lower House.
An Cathaoirleach: Members of this House cannot be referred to in their absence.
Mr. Leyden: A young Deputy from Roscommon, Deputy Naughten of Fine Gael has——
An Cathaoirleach: I told the Senator not to refer to Members of the Lower House.
Mr. Leyden: I was challenged by Senator Bannon.
An Cathaoirleach: It is I who will decide what is and what is not in order. I told Senator Bannon he was out of order.
Mr. Leyden: He is.
An Cathaoirleach: I am telling Senator Leyden that he is out of order.
Mr. Leyden: The Cathaoirleach will not allow me to play the tape either.
Throughout the country, Fine Gael Deputies and Senators and lawyers are abusing the unfortunate situation which has arisen. The Government will deal directly with the patients themselves. It will be in contact with them because it has the records, facts and figures. If there is a dispute in regard to these people’s estates, there will be a question to answer about who is eligible to collect the money.
Mr. Bannon: I am glad the Senator is acknowledging that the Government is robbing the elderly of this country left, right and centre.
An Cathaoirleach: I call on Senator Bannon to allow Senator Leyden to continue with his contribution.
Mr. Leyden: The Government will deal in an efficient and effective manner with its liability and responsibility with a heart and a half rather than half-heartedly.
Mr. Bannon: What has the Government done for the past seven years? Shame on it.
Ms O’Rourke: This issue arose 28 years ago.
Mr. Leyden: We do not need Fine Gael Deputies and Senators around the country engaged in a sordid campaign of exploitation. The Government will honour its commitment. The same Deputies who are complaining seem to be those who are promoting all the good the Government has done in the constituencies in the form of a guide to people’s entitlements for 2005. However, these people complain about what has been achieved by the Government, while exploiting what it has contributed.
I commend this detailed report and hope we can discuss it more fully tomorrow. Let us get on with the business. There will be a considerable cost to the State. Each case should be addressed on its merits. We must take responsibility on this issue. It is regrettable and will cost a considerable amount of money — possibly up to €2 billion — but we have a responsibility to those patients and we must honour it, open the vaults and provide the money.
Dr. Henry: It was a wise move for the Cathaoirleach to call me. While I realise that the Department of Health and Children is very busy and complex, we have seen an example of the most extraordinary maladministration within the Department. If one could feel that this was the only area in which there was the problem, I would not be quite so concerned. One could consider that this was one specific topic which was not addressed well or examined carefully enough over a very long time. However, there seems to be a serious lack of diligence in the running of the affairs of the Department which costs Irish taxpayers a considerable amount. While I know of the concern of the Minister of State, Deputy Tim O’Malley, for people with mental illness, it frequently seems to affect such people or, as in this situation, elderly people.
Members may have read in yesterday’s The Irish Times a report concerning Dr. Aisling Denihan, a consultant psychiatrist who carried out a survey of 89 recently appointed consultants in psychiatry to ascertain the status of the job. I heard her present the same information some months ago and I am glad it is now coming into the public arena, although I found it profoundly depressing. She consulted 89 of her colleagues and, according to the report:
Dr. Denihan brought some interesting facts to light. She stated she “was finally given a ‘beautiful suite of offices’ by her health board in Navan [but] it emerged that the building did not have planning permission to allow her to see any patients in it, so she has to see patients in their own homes”.
This is utterly ridiculous when one considers that in general health boards have approximately five months knowledge of when a new consultant will be coming forward. The Department of Health and Children has all the knowledge because it must make sure the funding is available before Comhairle na nOspidéal can advise appointments. It is a terrible waste of money. Dr. Denihan found that three months after taking up their posts, 44% of her colleagues were in much the same situation as her, namely, they did not have an office, clerical support, a junior doctor or a community nurse. I would like to be able to say that when they got going, all was well. However, worse followed because the funding for the support services was not in place. When Dr. Denihan eventually got up and running, she found that the funding had gone. A manager told her it had gone “to the corporate good”. What sort of waste of money does this represent? It is totally ridiculous.
In today’s newspapers, we read that Dr. Oscar Breathnach, an oncologist at Cork University Hospital, has resigned stating he would be moving to Beaumont Hospital because after four years in Cork he still had not received the required back-up staff. There is no point appointing a person without appointing the team needed to work with that person. I have seen this repeatedly and I regret to say the problem is getting worse. I have frequently pleaded with colleagues who returned to Ireland from the United States or the United Kingdom not to leave jobs because they were so disillusioned after two years here. However, the Minister of State knows that some of them leave after deciding the promises made to them would not be realised. This is an appalling waste of their time and our money.
Something must be done to improve the administration of our health service. When the Health Service Executive legislation came through the House, I was the one Member on this side who voted in favour of it, although some other Members voted against it because it was guillotined. However, while I supported the Bill, I am afraid it was just re-branding. We will be certain of this in a year or two.
If the events concerning nursing homes had taken place in a major multinational company, I do not know what would have resulted from such an appalling level of communication. While I will not judge who is at fault, there is some political onus on those who passed through the Department because I am sure it must have been mentioned to them at some stage. However, the other part of the Bill provides for doctor-only medical cards for, we hope, some 200,000 people. I do not oppose the doctor-only medical cards; to have one is better than not having a medical card at all. Despite the involvement of the Minister of State in the pharmaceutical industry, I am sure, like me, he does not believe there is a pill for every ill. As the number of medical cards has fallen by approximately one third under this Government, I am sure much good can be achieved with the doctor-only card. However, I have concerns with the logistics of the process.
When the over 70s medical card was introduced, I welcomed it despite thinking others were more deserving at the time. However, I would not have welcomed it if I had known of the lack of logistics in regard to how it would be applied. For example, there were twice as many people over 70 than had been expected. I discovered later that this oversight was not the fault of any of those working in the Department of Health and Children because the decision was made shortly before the budget speech by the former Minister for Finance, Mr. McCreevy, in which it was announced.
What planning has gone into the production of these cards? Will all the cards come on stream on one day? Will there be a doctor-only card day? Will the primary health care service, which is sadly underfunded and has terrible problems in many areas, simply be told to cope? One of the most serious problems is that there are areas without general practitioners. Therefore, some people will receive cards to visit non-existent doctors. Moreover, we know that people use doctors more often when they have a medical card, probably because they need to and should visit their doctor. From the perspective of preventative medicine, I welcome this. Will there be any increase in the funding of primary health care so that doctors can employ more practice nurses or receptionists, for example? We have not been told if this will be the case.
The process seems not to have been thought out. I do not know how it will operate except as one great shambles in which people will turn up at the surgeries of general practitioners, who will be told to cope with the situation. Theirs is not to reason why, but to do and die or live on, if they can, and keep going. There should be more consultation with those working in primary care so people receive the treatment they deserve.
There appears to be considerable discretion in regard to the granting of the cards. I remember the bad old days when discretion was very important in acquiring medical cards. I hope this does not recur.
I have concerns with section 5(3), which states “Insofar as it is considered practicable by the Health Service Executive, a choice of medical practitioner shall be offered under the general practitioner medical and surgical service made available under this section.” This suggests we could, if we are not careful, return to the days when there was no choice of general practitioner. This would be dreadful when we consider the great improvements made by allowing medical card holders to have the same choice private patients had.
Mr. Scanlon: I wish to share my time with Senator Mansergh.
An Cathaoirleach: Is that agreed? Agreed.
Mr. Scanlon: I welcome the Minister of State to the House and congratulate the Tánaiste and her Department on bringing forward the Bill so speedily. Many elderly people are in or waiting to get into long-term care hospitals and there is much confusion in regard to the current situation. While this problem arose almost 30 years ago, the Bill will resolve it once and for all.
We can get into the blame game if we want but that will not solve the problems for the many people who need the service. Following the court ruling, whatever charges are introduced for elderly people and their care will be put on a sound footing by this Bill. It has also been pointed out that the contribution made heretofore is approximately 10% of the cost of the care provided and I do not know anyone in a nursing home or anyone wanting to get into one who is not prepared to or does not want to contribute in a small way to paying for the fine service provided and the excellent way in which people are looked after. This problem has gone on for a long time and I am glad it has come to a head. We must deal with it. The Minister and his Department have worked very quickly to ensure we address the problem.
Some Senators have belittled the 200,000 extra medical cards. There are many people who would be glad to get such cards. Many people who are working and earning what we think is good money find it difficult to attend a doctor and pay perhaps €60 or €70 if their children or they themselves are sick. To many people that is a substantial sum of money which they might not have. People will be very grateful when they get these medical cards.
The refund scheme has been discussed in the House earlier. I agree with Senator Bannon that the help line is a problem for elderly people who are often left waiting. One can be lucky. I know people who have got straight through and have had their problems dealt with. However, many people wait up to ten or 15 minutes. Nevertheless there is on-line access too and forms are available via e-mail. Most Senators and Deputies now have those forms. Many people are asking how they can apply or contact the relevant section but the problems will be resolved quickly.
Dr. Mansergh: I welcome the Minister of State and his officials. I also welcome the Bill. The Minister of State will not take it amiss if I say that some issues progress by trial and error and this is probably one of them. One would hope to arrive at the right result in the end.
The Bill falls into two parts. There is first the question of legitimising the charging of patients for care and maintenance. There has been a good deal of debate on that over the past couple of months and in general most commentators and political parties accept the principle. It has not been fiercely attacked from any substantial source.
The Bill refers to a maximum take of 80% of the non-contributory pension. That strikes me as being rather on the high side. I have not done an exact calculation, but an old person left with a maximum of €30 or €40 a week might want to buy a couple of things for himself or herself or family members. This does not leave people with very much. I hope this section is interpreted as meaning a maximum rather than a norm. I would hope that the norm would be 10%, 15% or 20% below the maximum. I am realistic enough to know that with hard-pressed agencies that may not often be the case but in my view, 80% is a bit on the high side although I have no problem with it as a maximum.
The other part of the Bill is meant to provide a statutory footing to the new type of medical card. Despite the criticisms, the card is welcomed by the general population as far as it goes. It is also welcomed by most general practitioners. At least it means that if people are worried about their health and fall within the relevant category they can attend a doctor without having to pay a substantial charge. They do not have to sit about worrying. There are very definite limits as to what can be paid out in terms of medication per month or per year. The card is an improvement.
I have not been in the House for much of the debate but I heard the discretionary element being criticised. If we want humane legislation and humane public administration there must be some discretion. A rigid rule-based system allows no account of personal circumstances, of differing needs in what look on the face of it to be similar circumstances. No doubt the Senator who raised the point did not like the idea of political representations being made on behalf of deserving cases or perhaps undeserving cases. However, some discretion must be built into these types of rules.
There has also been some criticism about granting medical cards to the over 70s on the grounds that not all the implications were thought through. That brings me back to my original point about Government sometimes proceeding by trial and error. I am quite certain that when Donogh O’Malley announced free secondary education, all the implications were not thought through. It was a matter of making the announcement first and thinking through the implications afterwards.
Mr. Browne: On a point of information, Garret FitzGerald had planned to move on that issue.
Dr. Mansergh: Donogh O’Malley made the announcement——
Mr. Browne: After he heard that Fine Gael was planning to do so.
Dr. Mansergh: If we could revise history in that regard, Donogh O’Malley took the political responsibility and was backed by Seán Lemass. It is people who do things, not those who argue for things, who move on.
It is right that people over the age of 70 should have financial worries taken from them. That is a good reform. I have heard that the matter might be re-examined. I deprecate that because it is a good reform even if we have to work through its implications.
Mr. Mooney: I welcome the Minister of State, Deputy Tim O’Malley, to the House and note that once again he finds himself in the eye of a storm. When the storm broke over the constitutionality of charging elderly patients in long-stay care, I was reminded of a famous quote by a former Minister for Health, now the Minister for Finance, Deputy Cowen, who when asked to describe his situation in the Department of Health, replied it reminded him of Angola. The reference may have passed over people’s heads. On one famous occasion the journalist Vincent Browne stated that he could not figure out its meaning. Sadly, at the time the former Minister made the reference, Angola was the country containing the greatest number of landmines in the world. It was pockmarked with them, leading the former Minister to draw the analogy. Vincent Browne should take note of the explanation.
The two issues dealt with in this Bill are very straightforward. As the Minister observed, the introduction of this Bill brings clarity to the issue of the constitutionality of charging patients for the maintenance element of inpatient service in publicly-funded long-term care residential units.
I do not wish to go back over ground covered by other Senators like a variation on a theme. Members on all sides of the House have alluded to the crisis that struck the Government in the immediate aftermath of the Supreme Court’s decision on the constitutionality of the original Bill. Since then, the focus has been on the 29 years when the charges were charged illegally. However, the Minister is correct to emphasise that when the smoke clears, despite the drawbacks, the reality of the judgment is that the Supreme Court did not doubt that the Government is fully entitled to charge. The issue arose regarding its retrospective nature. I understand that a regulation was at fault rather than an actual law. To my mind, a regulation is in “division one” of the hierarchy of legislation. It was not passed at the relevant time to allow successive Governments to introduce this measure.
Inevitably, the Opposition will use the issue to score political points and if we were on the other side of the House we would do the same. The fact is that according to the court, the charge was levied illegally for 29 years and no-one spotted it or did anything about it. The Minister wishes to correct the legal anomaly and move on.
At the same time, she is taking the opportunity to introduce a second measure which will be welcomed by all who have concerns about the access by the more severely economically disadvantaged to local general medical services. It is a sad reflection on our society that despite our economic progress, a large cohort of people still exists for whom the cost of access to medical services is prohibitive. The Government should be applauded for taking this initiative along with the other legislative measure. It would reflect terribly on our society if parents living in economically-strained circumstances were discouraged from taking their children to see a GP for strictly financial reasons. In the Minister of State’s former professional capacity as a pharmacist, he must have been exposed to many people with financial difficulties in his locality. Knowing him as I do, I am sure he did his best to alleviate their problems and he must be particularly proud to bring this legislation through the House.
There was some criticism of the catch-all nature of the Government’s initiative to introduce medical cards for those aged over 70. If we are to be a caring society, what is wrong with taking an initiative of this nature? I use the word “society” rather than “government” to avoid having a political charge thrown at me. Those of us in a position to help others who are less fortunate should do so. While some people over the age of 70 are asset rich, despite the advent of the Celtic tiger they may not be cash rich. If God spares me until I reach 70 and beyond, I hope I will not be obliged to worry about the financial implications of my health but that the Government will acknowledge the contribution I made to the financial upkeep of the State and that it will repay me in my retirement. The acknowledgement is as much symbolic as it is financial.
Despite all their flaws, the Chinese have a wonderful philosophy in their approach to the elderly. The elderly are a respected part of Chinese society and of Asian society in general. We used to have such respect in our culture. Sadly, the all-embracing, consumer-oriented, fast-paced society in which we now live has eroded at the edges people’s traditional affection, regard and respect for the elderly. I make the observation to rebut the criticisms levelled at the Government about the catch-all nature of the initiative for those over the age of 70.
The Government has decided to go a stage further and target those within the medical card scheme who will benefit most, namely, the significant number of people who are socially and economically disadvantaged. Its initiative is part and parcel of being a caring Government. The Taoiseach has been accused of political opportunism for saying he was a socialist. A Taoiseach puts his or her own stamp on the Administration he or she leads. As Head of Government, all initiatives flow from the Taoiseach to other Departments in terms of policy and legislation. Given the Taoiseach’s background, he saw at first hand deprivation at its worst in the inner city of Dublin as he grew up. Why would he not claim to be a socialist, if it means directing his Government to introduce policies to help the deprived? As a recent report pointed out, many people are still deprived. Sadly, this most affluent of cities still has within it some of the highest levels of poverty anywhere in the Republic.
Dr. M. Hayes: I will be brief as the Minister of State has already heard most of the arguments and comments. Senator Mooney was somewhat kind to the subsidiary legislation by suggesting its flaw was minor when in fact it was ultra vires. It attempted to change the intent of the main legislation, not to bring it into effect. This is an elementary point and legal advice would have been clear and consistent on this over the years. However, we have a chance to discuss the issue tomorrow.
I have sympathy with two points made by Senator Mansergh. The first is that it is rather much to take up to 80% from an old age pensioner. It is all very well to say he or she would spend the money outside, but one is taking choice from them. A pensioner might decide to have another cigarette instead of another loaf of bread.
The second point concerned the need for flexibility. It is important to remember that what was done under the flawed legislation was neither irrational nor shameful. It is not an unreasonable principle to expect people to pay towards the costs of maintenance and ordinary expenses, particularly when the result of them not doing so is simply to increase the patrimony of their heirs. Whatever is done regarding the correcting of the retrospectivity of the charges, I see no grounds for paying the heirs and successors of people who were charged.
I would like to raise an issue regarding the health economics of the issue. I had some experience of this in another jurisdiction and some of the difficulties that have arisen in terms of definition and practice are the result of the blurring of the division between residential care and nursing care. That comes from the fact that people are living longer and frailer people are being maintained in these homes. There might be an argument for greater flexibility in determining what it is. Doctors were under tremendous pressure in the North, where there was a charging regime for residential homes, to certify people and keep them in hospitals, where they did not have to pay. There was huge resistance to the transfer of a patient from an acute hospital bed, which he or she was blocking up, to a residential home where he or she would be better looked after. There is a need to avoid those kinds of hiccups. There is much to be said for a comprehensive look at the system in general to see if providing more support to keep people in their homes might not allay much of this problem.
It has been stated that the full cost of granting everyone free care might be €300 million per year. I am not suggesting that this should happen. Even if it did happen, €300 million against a health budget of €10 billion is not an enormous sum if it produces savings and frees up acute hospital beds elsewhere. The Minister might ask some of his officials to examine what has happened in Scotland in the last year or so because the Scottish Parliament made the decision to grant nursing and other care to older people, a decision that was not replicated in England and Northern Ireland. It would be interesting to see the difference that decision has made. I would like to reinforce the plea made by Senator Mansergh for flexibility. A maximum amount that might be charged could be proscribed but after that, professionals should be allowed to deal with the individual case in a way that maximises the benefit to the individual and reduces generally the burden on the health services.
Mr. O’Toole: I would like to make a brief intervention on the Bill. I have spoken over the past week or so with a number of different groups that have concerns about some of the elements in it. I do not oppose the levying of some form of payment; there should be some form of payment where people can afford it. I am clear on the Supreme Court’s reflection on this fact. The court did not object to the retrospective element of it. However, the court ruled that it was depriving people of their private property. It was a constitutional point about the protection of private property.
I agree in principle with the general thinking behind the argument that a person in a nursing home whose only income is his or her pension should be prepared to pay a significant portion of it towards the costs of their care. If we could look at the practice of “a third, a third and a third” used in many parts of the professions and if a person in a nursing home could keep one third of that money for himself or herself and pay 65% or 66.3%, it would be considerably fairer and easier. I am making this point on a human level because the amounts of money are not hugely significant to the State but the amount of disposable income for people in nursing homes is very important. It is about having the money to buy the little things like a present for a grandchild, to be able to give at some stage at some time.
I ask the Government to have a rethink on the Bill. I am aware that it will not accept amendments here because I am sure that the last thing it wants to do is to bring this Bill back into the House. However, I consider there is a need to put down an amendment, to discuss this part of the Bill further and to hear the rationale. If we accept the rationale that there should be some element of payment, could I ask the Minister to ask for an examination of how it should be implemented?
We should ease back when implementing this policy and recognise how we can significantly help people. We are faced with paying back an amount that the pundits put at up to €2 billion. I do not know if this figure is correct in terms of the assessment of the total cost of the mistakes that were made over the past 20 years or so. I will not dwell on this aspect now as we will be debating the whole issue in the House tomorrow. However, I would ask the Minister to outline how much it would cost the State in net terms if we reduce the amount demanded of pensioners to two thirds of their pension. Reducing the amount to this level would give a great element of independence and dignity to people who have given their all to this country and show that the political establishment empathises with them. The Government should reflect on this.
Minister of State at the Department of Health and Children (Mr. T. O’Malley): I thank the Senators for their contributions to this debate. Regarding the 80% charge mentioned by one or two speakers, this is a maximum of the old age non-contributory pension that can be deducted. There is flexibility in this regard.
Senator Henry raised a point about flexibility regarding the doctor-only card and expressed concern over whether patients would have a choice of doctors. Patients will have a choice; the arrangements will be the same as those for the medical card scheme. I am not pleased to see some politicians placing advertisements in the newspapers advising people to go to clinics for this matter. This practice politicises the issue and does not help the situation. I was unaware of these advertisements until I came into the Seanad this evening.
I agree with Senator Mooney that the Government is trying to respond in a humane manner to a problem that has been before successive Governments for 29 years. This extremely important legislation represents a symbolic gesture to the over 70s and we must get it right.
Senator Henry referred to a recent newspaper report about psychiatrists who are appointed and left for months or years before getting a team or accommodation. This is the first time the matter has been brought to my attention but it worries me. It is a waste of expensive resources if the consultants’ management fails to put in place working facilities and registrars for them. Senator Henry gave an example of someone who did not have an office or secretarial staff for several months after being appointed. It is extremely disappointing that this could happen in this day and age, especially when Comhairle, the Government and the HSE appointed these people.
The Government has introduced this Bill to establish a sound legal basis for the policy of requiring some contribution towards the shelter and maintenance of people with full eligibility in long-stay institutions. The issue has been put beyond legal doubt after nearly 29 years as the Supreme Court has confirmed that it is constitutionally sound for the Oireachtas to legislate for this policy. The other matter addressed in the Bill, the introduction of a doctor-visit medical card, is a major step in ensuring that people of low incomes will have access to GP services and advice. Senator Mooney referred to the evidence that many people, particularly mothers of young children, are just above the limit for a medical card and have problems if there are illnesses in their families necessitating several visits to doctors in the space of a month.
It is important that the Government has taken this decision to allocate GP-only medical cards. The general public and the future recipients of these cards welcome them as they will be a consolation for many families, especially those with young children. It has always been a problem that children are struck by illness most often. A mother may unexpectedly be at home with two or three sick children, which can cause undue hardship for families. I do not view this as a generic or yellow pack card, as some have called it. It will be extremely significant in helping many people and families.
The HSE was established to administer the health services on a national basis and will be in a position to commence the introduction of these cards as soon as the Bill has been enacted. It is a long-standing feature of our system under various Governments over 30 years that most people in publicly-funded long-term care should make some contribution to the cost of their care. Quality care is expensive and the bulk of the cost must be borne by the Exchequer alongside these contributions. The quality of care provided in many public nursing homes and what were formerly called workhouses, now public institutions, is far superior to many of the most expensive nursing homes. It is wonderful that successive Governments have raised the standards and it is a tribute to the care and diligence of the nurses and doctors involved. I am sure Senators agree with me.
The income foregone by the HSE for as long as these charges cannot be raised is estimated to be in the region of €2 million per week. Even if one does a quick sum and agrees with Senator O’Toole on reducing that figure by 10% to 20%, the amount lost to the State will be sizeable. However, there is flexibility in the scheme and the HSE will have the right to waive charges.
A statutory framework that puts the long-standing policy on a sound legal footing and safeguards the income generated from this source is vital. The provisions of the Health (Amendment) Bill 2005 will secure this source of income, which has been an essential element to the funding of our health services in the past and must remain so. The introduction of a doctor-visit medical card is the most efficient way to help a significantly increased number of people to access primary care. It is in line with the commitment contained in the health strategy to ensure that the allocation of medical cards is on the basis of prioritising the groups most in need and is intended to benefit approximately 200,000 people. Those who speak about the percentage of people on medical cards are missing the point. If those who use the services most are prioritised, it is right that the Government proceeds with this and gives GP-only cards to young families, as they will benefit the most.
I will respond to some of the points made by a number of speakers during this debate. Concerns have been raised that the percentage of the population covered by the medical card has declined in recent years. It must be recognised that this is attributable in large measure to the economic success Ireland has enjoyed, which has reduced the need of many people for State support to meet health care and other living costs. The Government’s objective is to ensure that the people most in need have a medical card rather than simply achieving coverage of a certain percentage of the population or issuing a specific number of medical cards. In order to give effect to this targeted approach, changes to the income guidelines expected to result in the issuance of an extra 30,000 medical cards in 2005 have recently been introduced by the HSE at the request of the Tánaiste. This is in addition to the doctor-visit cards, which will be introduced subsequent to the passage of this Bill.
The Department will ask the HSE to keep the medical card’s revised income guidelines under close review to ensure that the Government’s policy decision on the extra 30,000 cards is delivered upon. I emphasise that there is no question of the Government seeking overtime to reduce the number of standard medical cards in favour of issuing increased numbers of doctor-visit cards. This initiative is intended to complement the existing arrangements that have been in force for many years. Several Members of both Houses were under the impression that the Government has taken the decision to change the former full medical card into the doctor-only card. The Government has taken a conscious decision to make this an add-on.
The Department of Health and Children has recently written to the interim CEO of the HSE to formally indicate that the Government’s objective in introducing this initiative was to enable in the region of 200,000 medical cards to be issued in respect of general practitioner services. The Tánaiste wishes to have the necessary administrative arrangements in place to enable the new cards to be issued from April onwards.
The HSE has been requested to have the necessary preparatory steps taken and operational guidelines developed, such as will enable applications for doctor-visit medical cards to be accepted as soon as possible after the enactment of the relevant legislation, and the cards subsequently issued to persons who meet the relevant criteria. It is important to emphasise that with the establishment of the HSE, the administrative arrangements for this card will be operated on a standardised basis across the country.
The Department has written to the Irish Medical Organisation to notify it formally of the Government’s decision regarding doctor-visit medical cards and of the provisions of this Bill. It has also indicated that the HSE has full operational responsibility for the delivery and funding of all health services and that it is the appropriate body with which the IMO should deal with regard to the introduction of these cards.
I wish to reiterate that while the HSE intends initially to set the income threshold for the doctor-visit cards at 25% higher than applies for the standard medical card, this threshold will, if necessary, be reviewed in the light of experience so as to ensure that the desired number of cards are issued to those intended to benefit under the initiative.
The Bill will bring clarity to the issue of charges for long-stay care where it is clear there has not been a sound basis for the practice going back almost 30 years. The legislation will also ensure that the income flow from charges imposed to date will remain secure and continue to support and continue to support the provision of quality services to those in long-term care. I am pleased that none of the major parties have registered any difficulty with the principle involved here.
The introduction of doctor-visit medical cards is a supplementary initiative which will enable some 200,000 additional people from lower income households to attend a doctor free of charge. This will help to overcome barriers to assessing general practitioner services for many individuals and families who are above the standard medical card income guidelines. I thank all the Senators for their contributions.
Question put and declared carried.
Committee Stage ordered for Thursday, 10 March 2005.
Acting Chairman (Mr. Ó Murchú): When is it proposed to sit again?
Mr. Scanlon: At 10.30 a.m. tomorrow.
Mr. Bannon: I thank the Minister of State at the Department of Education and Science, Deputy de Valera, on behalf of Ballymahon vocational school and myself, for taking this matter. Ballymahon, County Longford, is a town that has seen significant housing development in recent years. Current building schemes will bring an excess of 600 new dwelling units, considerably increasing the demand for school places in the locality. This will put an even greater than heretofore pressure on Ballymahon vocational school, which has a proud tradition of serving the community in providing first class facilities for its students and the increased pupil intake.
Currently, the school is at stage 3, architectural planning stage. It urgently needs to progress to stage 4 of the building programme. Ballymahon school makes every effort to maintain a learning environment that is as agreeable and attractive as possible and the students’ commitment to this approach can be seen in their care for their school environment. The many achievements of the school have been accomplished despite the inadequacies of the school facilities.
The students deserve all the help we can give them to achieve their full potential. This is hampered by a school building in serious need of refurbishment. It is a building that falls well short of safety legislation requirements for a learning environment. Fittings in the building are obsolete and inadequate, electric wiring is unsafe and woodwork is decayed, with extensive dry rot. There is an urgent need to convert a room into a general purpose room. The school computer room has serious safety problems with unsafe electric conduit and wiring.
The woodwork room was constructed in 1963 and is urgently in need of an equipment up-date and refurbishment. The electric wiring in this room is also unsafe as there is no isolating switch. The bench-saw is also unsafe with inadequate guard and dust extraction. The home economics room has an obsolete solid fuel cooker, obsolete furniture and fittings and unsafe power sockets hanging form the ceiling that are a health and safety risk. The poor hygiene levels caused by the inadequacies of the boys’ toilets are a cause of great worry. Drains present a continual problem and the floor is unhygienic. There is no wheelchair access to these toilets and given the state of the fittings and the floor, it is impossible to keep them in a suitable condition.
The unsafe condition of the science room is extremely worrying. The poorly equipped room is a health and safety risk, with gas, water and electricity controls within a 30 cm. radius of each other and with only an on-off control switch on the gas supply. Wheelchair access to the school building is extremely difficult. There is no wheelchair access to the first floor and the health and safety officer has condemned the building as a fire hazard with no fire exit in place.
How does the Minister of State think the parents feel knowing that their valued children, for whom they want only the best, are being educated in such a risk filled environment? The students and their parents deserve better. They have a right to a safe, healthy and secure physical environment. I strongly urge the Minister of State to ensure this is provided for them. I recently met the principal, Mr. John O’Donnell, and Mr. Brendan Quigley of the board of management who pleaded with me to raise this matter and bring it to the attention of the Minister to ensure the refurbishment progresses to a satisfactory stage as soon as possible. I am sure the Minister of State must agree from what she has heard that there is need for urgent work to be carried out at this school.
Minister of State at the Department of Education and Science (Miss de Valera): I thank the Senator for affording me the opportunity of outlining the proposals of my Department regarding the proposed refurbishment project at Ballymahon vocational school, County Longford. The building unit of my Department received an application from County Longford Vocational Education Committee for the refurbishment of the existing building at Ballymahon vocational school and the proposed project was included in section 9 of the 2004 school building programme. This means the project is at early architectural planning. The project is at stage 1, initial sketch, and has a band 2 rating.
Officials from my Department are reviewing all projects not authorised to proceed to construction as part of the 2004 programme, including the project at Ballymahon vocational school, with a view to including them as one of a number of schools listed to progress through architectural planning. Over the past few weeks my Department has also made a series of announcements relating to the schools building and modernisation programme, which included 122 major school building projects authorised to prepare tenders and move to construction during 2005; 192 schools invited to deliver their building projects on the basis of devolved funding; and 43 schools authorised to commence architectural planning. My Department plans to make further announcements regarding schools whose projects will progress through the design process together with details of schools identified as suitable for construction under public private partnerships.
I am delighted that my Department recently announced the successful applicants for the 2005 summer works scheme. With more than €62 million available for works deemed absolutely necessary, which is double the 2004 funding, we have provided 590 schools with funding under the expanded scheme this year. The increase in numbers of schools applying and projects involved is evidence of the success of this scheme. All the projects approved have been assessed as priority projects by the schools themselves. There is also the minimum of disruption for the school community as work is carried out during the summer months.
Works of an urgent nature required to be undertaken at the school may be addressed through the summer works scheme. The school made an application under the 2004 scheme for the refurbishment of a science laboratory but this was not deemed absolutely necessary as per priorities detailed in the circular of the scheme. In 2005, €270 million will be allocated to primary schools and €223 million to post-primary schools for building and modernisation works, which represents an increase of 14% on last year and is six times greater than in 1997. I thank the Senator for the opportunity to outline the current position in this case.
Mr. Bannon: A total of €223 million has been allocated to post-primary schools and I ask the Minister of State to prioritise Ballymahon vocational school because the refurbishment works are urgent.
The Seanad adjourned at 8.35 p.m. until10.30 a.m. on Thursday, 10 March 2005.