Seán Ryan (Dublin North, Labour)

I am pleased to have the opportunity to make a contribution to this important issue and to compliment Fine Gael on tabling the motion. The Government's record in bringing forward promised legislation is abysmal and it is particularly bad in the health area. It is quite disgraceful that we do not yet have the necessary legislation to refund the illegal charges paid by people in nursing homes. No other group would be left waiting for over a year to have its money returned to it.

We do not yet have the promised legislation on the health information and quality authority. The heads of the Bill have not even been drafted although this authority is considered an essential element of the reorganisation of health services. The delay in bringing forward the legislation on an independent inspectorate for nursing homes is even greater. The health strategy 2001, which was launched with such aplomb, now lies in shreds with virtually none of its promises fulfilled. This failure is greatest in the case of older people. We do not have any new public nursing home places, we have no new strategy for the care of older people and we have no independent inspectorate.

The fact that the legislation on an independent inspectorate has not been afforded priority reflects the Government's lack of concern for one of the most vulnerable groups in society, that is, those who are no longer able to continue living in their own homes because of age and infirmity. The failures in the nursing home sector are well known. What else needs to come to light for the Government to take action? That it knows there is a problem and is failing to do anything about it is evidence, if it is ever required, of the lack of priority it affords to the inspectorate.

On a number of occasions I have had reason to raise in this Chamber the scandal that elderly people in need of long-term care in public nursing homes in areas of Dublin are now facing a waiting period of up to 12.5 years. That is a fact. In the first instance, priority is being given to the removal of residents who are taking up acute beds in one of our hospitals. Consequently, many elderly people are forced to remain at home relying on family support. Community care and the home help service are being cut back, irrespective of what the Minister of State says to the contrary. Commitments towards extra funding do not even match the cuts made over the past two years. This is happening at a time when beds are unoccupied in the public sector and when there are also beds available in private nursing homes.

I wish to raise the issues of inspections and uniformity of standards in nursing homes. There are no inspections of the State's 500 nursing homes, which care for 12,500 people. I have been informed that there are not enough staff to ensure that, in all areas of the country, the requirement of two inspections of private nursing homes per year, as required by the Health (Nursing Homes) Act 1990, is met. I firmly believe there is a need for the establishment of an independent inspectorate. It is shameful that the Government has not acted on the main recommendations of a series of published reports that call for independent inspection of nursing homes. There is no specific legislation dealing with the quality of HSE long-stay care places for older people and the places are not subject to an external assessment of quality.

Existing legislation governing standards of care is extremely vague, to say the least. The providers or funders of public care homes, the HSE areas, are themselves the regulators of the private sector. One of the points that must be faced up to is that behind the State's reluctance to see an independent inspectorate is a belief that its establishment could result in damning reports of the standards, comfort and staffing ratios in many of the State's public nursing homes. Major questions regarding the age and physical structure of homes, as well as allegations of abuse and neglect, need to be addressed as a matter of urgency.

The Human Rights Commission's report on older people in long-stay care, dated 2002, states there is a need for systematic study of the inspections carried out by the HSE to determine, for example, whether the statutory requirement to have two inspections per year is being met. The study would indicate the sorts of problems being identified and the action taken to address problems. It would determine whether there are structured interviews with residents' relatives, whether health boards have consistent standards, whether inspections are sufficiently broad to provide information about the quality of life of residents and whether the HSE is being sufficiently rigorous in following up when problems are identified. The latter point is vital. It is difficult enough to get a reply to a question from the Department without it referring the question to the HSE. It is important that there be a follow-up.

A systematic study would determine whether the HSE is reluctant to close homes because of a shortage of places, whether the powers available to the inspectorate are adequate, whether the reporting arrangements are adequate, whether all reports should automatically be made public — this is very important as it has not been the case to date — and whether there should be a facility for the inspectorate to report directly to the Houses of the Oireachtas or committees. This must be intrinsic to any legislation brought before the House. I ask the Minister of State to take this on board.

Other fundamental issues that must be addressed in legislation involve older people who need care or older people for whom care is not provided in the community, who cannot get a HSE area place and who cannot afford private nursing homes. Such people are left in limbo and this must be addressed. What are the implications of all these issues?

We must tackle the lack of equity in health services and the apparent lack of a concerted approach on the part of the relevant bodies, especially the Government and the HSE, to addressing these issues. Included in this is the obvious lack of relevant community care and support for older people. The need to formulate policy and, above all, implement that policy is not just a matter of the rights of older people who have contributed to the development of our Celtic tiger but it also concerns recognition of the fact that all of us are entitled to a future of dignity and equality, which I regret do not exist at present. It has been clear for some time that the situation facing many older people has reached crisis point. There has been a lack of emphasis on older person's issues. If it had not been for the efforts of the Opposition — myself, the Labour Party and Fine Gael — in this House for the past ten years to raise these issues consistently, there would have been no movement, which should be acknowledged.

We all know that the Government does not like freedom of information legislation and it has already made it more difficult and more expensive for people to use it. The health boards did not provide adequate information about the services they provided but the HSE seems to be even less forthcoming. It seems that the Department of Health and Children and the HSE are in breach of their obligations under the freedom of information legislation to make available information to the public on matters which affect them. Neither body has the manual of its procedures, known as the section 16 manual — the Minister of State should look it up — readily available as is required by the legislation, which is a scandal. The HSE seems to have no clear view of its obligations under the legislation, which I regret.

Prior to the highlighting of the Leas Cross scandal on "Prime Time", successive Ministers for Health and Children and Ministers of State at that Department were aware of the problems that existed with the operation of private nursing homes. The Minister of State, Deputy Brian Lenihan, speaking on a Private Members' motion on nursing homes in June 2005 stated that there was no doubt about the shock that resounded throughout the country following the transmission of the "Prime Time Investigates" programme. He also said that the Government had a commitment to older people. It has a peculiar way of showing it. Action is required, not meaningless scripts. I hope Deputy Sean Power, as a relatively new Minister of State, will take on his officials on this issue if they are not prepared to come forward with the required legislation. He has made commitments in the past. He should stand up and be counted on this important issue.

Well before the Leas Cross controversy, in response to questions in the House, I was told by the Tánaiste and Minister for Health and Children and her Department that on the basis of the existing inadequate inspectorate, they had found that staffing levels and nursing policy issues were relevant and needed to be addressed, maintenance of accommodation standards was deficient, hygiene problems existed in nursing homes and there was lack of activity for residents. We should try to imagine getting up at 7 a.m. and remaining sitting in the same chair until 10 p.m. before going to bed. The Minister and her Department also found evidence of insufficient record keeping, lack of active involvement with local authorities on fire safety issues, lack of equipment appropriate to clinical practice, such as pressure mattresses, and a discrepancy in the contract of care.

Basic information on the care of residents in nursing homes was withheld. It is time we opened the halls and windows of the Department of Health and Children. We should stand, once and for all, for the older people who have done so much for this country. Let us stand up to the bureaucrats and bring forward the legislation. Nothing less is required.

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