Paul Gogarty (Dublin Mid West, Green Party)

I thank the Chair for allowing me to speak following the mix up in slots. We have been waiting for this Bill for almost a year and a half and we are still on Second Stage. I realise there is other important legislation to be dealt with, particularly that to be taken tomorrow which should supersede everything else, but this Bill is dragging on and is unlikely to be approved until the autumn, which is regrettable. That may be bad but what is even worse is the scandalous delay, to paraphrase Deputy Joe Higgins, in introducing the legislation on an independent inspectorate for nursing homes. That is even more urgently needed given the reports on Leas Cross and other facilities published in the past 12 months or so.

It appears that all important legislation debated in this House is forced upon the legislators as a result of events, to use that unfortunate term, or court decisions. We have only to witness the sorry situation regarding the release of the child rapist dubbed Mr. A and the possibility that in an hour's time Mr. B might also be released to realise that the Government was caught napping and had to react. In that respect I welcome the legislation to be debated tomorrow on the age of consent and the rape of children, which is crucial. I refer to it in case I do not get a chance to do so tomorrow.

Similarly, this legislation is being debated as a result of events, namely, the revelations about conditions in Leas Cross nursing home and also, to a lesser degree, the fall-out from the payments issue and the illegality that arose around the same time. The appalling treatment of a few individuals in one facility brought on a media investigation which highlighted other cases throughout the country and brought the mistreatment of the elderly to widespread public attention. That is one of the reasons this legislation comes before us now.

This legislation is flawed in respect of one issue, namely, the implementation factor. I will deal with some of the issues in the Bill in due course but the conditions surrounding this at the moment are chaotic. It is a time of chaos in the health service. We have no new public nursing home places, despite a commitment made by the Government that 2,000 would be provided. We have no new strategy for the care of older people and, as I said at the outset, no independent inspectorate.

This Bill appears to be a charter for the rich and a slap in the face for every other older person who has contributed to society over many years. Social welfare recipients are being told they can pay for a private nursing home when no public ones are available. Although the Supreme Court upheld their rights, their rights continue to be trampled on because subventions, about which there is much reference in this legislation, mean nothing in terms of private nursing care if one does not have the money to top up one's social welfare payment. Enhanced subventions, which other Members spoke about, might be available in some cases but eventually, under the current funding arrangements, people will be drawing lots or told, as one speaker said some weeks ago, that they have to wait for someone to die. That is not good enough and it will do nothing to help take out of the public hospital system the elderly who cannot afford private care. It will mean people will continue to live in poor or unsuitable conditions for many years until someone dies and a public space becomes available.

There is only so much outrage one can spout in this Chamber without sounding like one is playing to the gallery but this is one issue — and I have said it in regard to nursing home charges and repeat now — that is an absolute outrage in terms of our older people. It is an outrage and a scandal that the people who paid the highest taxes and contributed to the birth of the Celtic tiger are now being mistreated in this appalling fashion.

While we have some amendments to the legislation to introduce a system of approving those who may qualify for public and possibly private nursing home care, we still have not tackled the fundamental issue of paying for it. That is the problem. The legislation only ensures that the sorry situation that currently exists has some form of legal protection, rules and regulations. I have examined some of those in terms of what constitutes a person's ability to get different types of funding in various scenarios and the worst case condition is where a person does not have a top-up pension and is on the lowest social welfare payments available. This does not do anything to facilitate people entitled to public nursing home places to get into private nursing homes. That is just one issue.

My colleague, Deputy Gormley, who is health spokesperson for the Green Party, related to the other factor in the equation in terms of the lucky few who get into private nursing homes. That is a lottery, however, in that people cannot tell whether they will find a facility that will care for them. We know only a minority of establishments have been shown to be seriously lacking but in many cases because of cost and geographical factors, one cannot necessarily choose where to go. The issue of choice is a real one. We can say people can look around or the sons or daughters of the people in question, or they can visit a few places, be sold a few platitudes and in they go. It is very difficult to get out of a situation like that when one has committed oneself financially. That is for the people who can afford to commit themselves financially. For those who cannot afford it, we are talking about people who are left in their homes in a condition where they cannot look after themselves and where there is no community care, even though community care is supposed to be provided.

I will quote from a letter written by a health care worker who, for obvious reasons, wishes to remain anonymous but it outlines some of the concerns being expressed. The letter was written to Deputy Gormley following his comments on radio about the poor care in nursing homes. This individual states:

I too have very major concerns that the HSE and the Department of Health are not taking the issue seriously enough . . . [That is the issue of nursing home care] . . . and in particular that the HSE are more defensive of themselves than of the care and well-being of the vulnerable people who are supposed to be protected by them. Your report [that is Deputy Gormley's report] of staff concerns effectively being stymied by insisting that they are formal complaints has a ring of truth.

Sadly, this attitude is all too evident in their approach to Professor O'Neill's report on Leas Cross, which has been with them since February (first draft) and a relatively unchanged second draft . . .

According to this person it appears that the attitude is more about concern for the impact of the report on senior HSE staff and recently retired staff who have returned on contract rather than patient care. The person finally states:

It would be of great service to the public if the report were released promptly as it outlines a series of system failures which require urgent attention, and which are likely to mean that poor care is widespread and unchecked in the nursing home system.

I deeply dislike writing anonymous letters — this is the first in my life — but you are aware of the culture, and it is good to hear a sympathetic and firm approach.

Yours sincerely,

A concerned HSE healthcare worker.

It has got to the stage where members of staff are writing anonymous letters even though Deputies and Senators do not make names available under the Data Protection Act but this person was so afraid that their name would get out as having criticised the malaise in the health care service they would not give it.

The point that person made was valid. Members of staff are afraid to raise issues until they turn into major issues with formal complaints, de facto identification of those involved and the risk of intimidation. Why can the system not be made easier? The establishment of an independent inspectorate for public nursing homes would help so why the delay? Deputy Gormley and others have tabled questions to the Tánaiste and Minister for Health and Children about this matter and on his behalf I intend to ask her whether the Government has lost all credibility on the issue. Is the Government trying to drag it out because an inspectorate might identify problems which exist, both in terms of the care provided and in terms of the substandard accommodation which still plagues our system?

In contributions, Deputy Gormley and others referred to the long list of inadequacies which were identified, but it seems nothing will be done about them. The Government has reneged on its commitment to provide public nursing homes, and it is not training sufficient specialists, or even those who are not specialists but who require a modicum of training to carry out duties effectively.

The issue of community and public care units is not being looked at. Lip service is being paid to the matter, but I do not see them on the ground. Other Deputies have spoken on the issue of community care. It should be remembered that only a small minority of older and vulnerable people require full-time or part-time care. If possible, such care needs to be carried out at local level within the community.

In my constituency, the St. Loman's Hospital lands were sold for €31.5 million, and it is worth noting that some of that funding is going towards community care. I welcome that, although I realise it is for mental health issues, though some of it is for elderly people. The money should be spent within the area rather than being dispersed for hospitals for elderly people.

In ten years, hospital beds will still be taken up by older people unless investment is made to open 2,000 community care places. These are meant to be separate beds for older people. Not having a background in health, I sometimes get confused by the use of the word "beds" for elderly people. These are separate to beds for people who have medical conditions. There should be no place for an older person in hospital unless they have a medical condition, even if it is in an annex. These people belong in the community, be it in a properly inspected public nursing home or a private nursing home if the person can afford it.

Deputy Gormley also referred to the wider issue of people not necessarily having to go into nursing homes because they may be living longer, be independent and healthy. There is an issue regarding the overall treatment of older people and Government policy on health care. For example, this relates to tax incentives for matters such as gym membership, active retirement associations or even mixing in adult education and subventions for VECs, which have diminished in recent times. It is now more expensive to do an adult education course.

These might seem distant or unrelated to the issue we are discussing, but the more people are kept active and involved both mentally and physically, the less likely they are to be dependent. For a relatively small investment for many people now, one would not have to worry about the nursing home issue, hopefully not ever and definitely not for a considerable period. The related holistic community-wide measures can also be looked at in parallel to the immediate emergency situation. The Government should be planning for both of these simultaneously so that in a few years, we do not have more people who could have been active and engaged in the community but who are on the scrap heap because of a lack of foresight in Government policy.

That is a serious indictment of the way we value our older people. Government policy must reflect respect for people who put me in my current position, gave me an education and made me as articulate as any other Member of this House in representing their views. Without the efforts of people like that, we would not have the calibre of Deputies and Senators which we have today, or the calibre of business people or teachers, for example.

The people who made our State the economic powerhouse it is today are those who we are trying to thank, but we are doing it very badly. We must recognise and respect what these people have done for us and give them the dignity and courtesy of a proper retirement with appropriate medical care and support. That is not happening. Without financial input accompanying the Bill, it will not happen. It seems to be a list of reasons why money will not be received as opposed to a list of guarantees. Under the Constitution one is entitled to health care, and the Government should back this up with money. There is very little in terms of additional financial investment.

We know there is a problem, and various Ministers with responsibility for health have acknowledged it. The Tánaiste and Minister for Health and Children, Deputy Harney, has also acknowledged that a problem exists. If a problem is recognised and nothing is done, it is a bigger sin than what has happened this week, where the Government indicated it could not foresee the Supreme Court decision. We foresaw the issue of elderly care and we have seen that we are not properly inspecting our nursing homes. We have seen this matter coming and we can do something about it this year.

Why are we not doing this? We should be able to see the problem, resource the solution and give our elderly the respect they deserve. At the next election there will be some new Deputies whose education was funded by people who are now in need of State care and who will be saying the same thing I am. They will argue that we need to respect our elderly. In five years I do not want to be saying I warned people but I was talking to a blank wall.

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