Liz McManus (Wicklow, Labour)

I welcome this debate and thank Fine Gael for the opportunity to speak in it. I start by reminding the House of the statement the Minister for Health and Children made recently: "It would not be acceptable to me or the Government if this report were to remain unpublished." However, the Minister for Health and Children has the power to guarantee publication and it is time for her to use it. It is quite simple. Instead of doing so, the Minister has called on the HSE and Professor O'Neill, the author of the Leas Cross report, to work together to create the conditions necessary to facilitate publication. As far as Professor O'Neill is concerned, and according to his interpretation of the terms of reference, the report is finished and ready for publication. It is time for the Minister to live up to her own rhetoric. She has the legal authority to break the logjam and I urge her to use it.

The Minister has power to issue directions to the HSE under section 10 of the Health Act 2004. The directions may be either general or specific. Under section 10(1), the Minister may issue general written directions to the executive "for any purpose relating to this Act or any other enactment, and concerning any matter or thing referred to in this Act as specified or to be specified, or as determined or to be determined, by the Minister".

Under section 10(2), the Minister may issue specific written directions to the Executive "concerning the submission to the Minister, in such manner and within such period as the Minister may specify, of reports on any matter relating to Part 7 (Accountability) or relating in any other way to the performance of the Executive's functions, even though such reports are the subject of a direction under subsection (1), and any information or statistics relating to the performance of the Executive's functions".

Subsection (5) provides that the executive must comply with a direction issued by the Minister under this Act.

It therefore appears open to the Minister to direct the HSE to provide her with copies of the O'Neill report. It also appears open to the Minister, once the report is formally in her possession, to refer it to the Joint Committee on Health and Children. The committee could then publish it, a precedent which has been followed on previous occasions. I was involved in such a process relating to the scandal surrounding sexual abuse in swimming. It is within her power to do so and it is time for her to match her words with action. The result of the ongoing failure to publish this report is the belief among many members of the public that these types of reports are commissioned but nothing ever happens. There is no personal accountability and the track record of Ministers for Health and Children on this is not good. The public deserves answers to the questions raised on standards of care for the elderly. The process of reforming the way vulnerable sections of our society are treated is stuck in a bureaucratic and legal quagmire and the valid fear is that it will be left there.

Some 16 months have passed since the screening of the "Prime Time Investigates" investigation into Leas Cross nursing home. This was not the first time the Government's attention had been drawn to concerns that the elderly, in particular those in long-stay care, may be particularly vulnerable to human rights abuses. The Human Rights Commission's report entitled Older People in Long Stay Care was published in November 2002. Its concerns over the inspection of private nursing homes were clearly stated as follows:

Inspections are rarely, if ever, carried out at night; the inspection is largely concerned with the physical conditions and rarely addresses what might be termed broad quality of life or social gain issues; the Health Boards take very few prosecutions and almost never close down a nursing home. The sort of breaches of the law which were regularly mentioned in the reports included the absence of contract of care, inadequate records of medication and the use of restraint, insufficient arrangements for privacy and the absence of safety equipment.

This report, which is almost four years old, elicited a response from the Department of Health and Children only seven months after its publication and even then the Department did not engage with the issues raised. A similar indifference by the Department of Health and Children and the HSE is now being experienced with the Leas Cross report.

In May 2005 "Prime Time Investigates" aired its investigation into Leas Cross which exposed degrading and humiliating treatment of its elderly patients. These elderly people are some of the most vulnerable people in the State. The treatment of these elderly patients in the care of this nursing home appalled viewers. It became a matter of national scandal and was discussed here in this Chamber. The images depicted so graphically on "Prime Time Investigates" were shameful for our society and it was shameful that this could happen in modern Ireland.

This is not just a case of elderly patients being stripped of their dignity but a system that is putting the health and even the lives of vulnerable, elderly patients at risk. What we witnessed was a Government that failed in its duty of care to its most vulnerable elderly citizens. The Government responded by making three promises: an independent nursing homes inspectorate, a team of elder abuse case workers and a report into the 95 deaths in Leas Cross. The Government has failed on all three promises. It has failed to publish legislation to establish an independent nursing homes inspectorate. In the days following the "Prime Time Investigates" exposure the Taoiseach spoke in this House. He makes many statements in this House and appears to subsequently change his tune. On this occasion, 1 June 2005, he stated:

Legislation to establish a proper inspectorate that will be independent of the HSE and deal with both nursing homes and children is being prepared. The legislation will not be ready before the summer but will be introduced in the autumn.

The Department of Health and Children now tells us it will be 2007 before this legislation appears. Appointments to the nationwide team to prevent elder abuse are critically behind schedule. Only five of the proposed 32 elder abuse case workers have been appointed. Although the report on the 95 deaths in Leas Cross has been ready since May this year it has not been published and it is time it was. The author of the report, Professor Des O'Neill, has described the findings as "grave, disturbing, requiring urgent attention". Professor O'Neill believes that the HSE's recent insistence on a "judicial form of tribunal" is outside the terms of reference as given to him. As far as he is concerned, this report is finished and should be published. Professor O'Neill stated:

As it turned out, the review that I conducted gave me cause for grave concern not only as to the standards within that particular nursing home but also, as the specific terms of reference required me to consider, the wider issues as to the setting of appropriate standards and their systematic monitoring and enforcement. As I have previously stated these concerns were grave, disturbing and system-wide, and required urgent attention.

Urgent attention is the one reaction we have not seen. The HSE's response is that this report is unpublishable, yet it must be published. It is up to the Minister to use her statutory powers to guarantee its publication. In the words of Mr. Dan Moore, relative of former Leas Cross resident Mr. Peter McKenna, this report must not serve as wallpaper to cover up the terrible neglect of these elderly patients. As Mr. Moore stated on the death of his relative: "To my knowledge not one person suffered embarrassment, was fined, imprisoned, suffered loss of job, loss of status — nothing".

The revelations of the "Prime Time Investigates" investigation resulted in elder abuse becoming top of the national agenda for a short time. It is time to make it top of the national agenda once more and to seek to fully protect our most vulnerable citizens. We cannot do it without having in the public arena the vital information in Professor O'Neill's report. It is extraordinary that taxpayers are paying for this report which is of grave public concern and which they are entitled to see. It investigates issues that affect our elderly across the board, not just in one nursing home. Even without the report's publication the one fact we know is that the phenomenon is system-wide, and that is why it is so important that the Minister deal with it. There are clearly wider failures in how our system cares for elderly citizens. That does not imply that we do not have good nursing homes. I know many people who are happy and well cared for in private nursing homes across the country. It does a disservice to those who provide that level of care to leave them in a limbo in which they all suffer from a stigma because the information that should be published is not being made available and action is not taken.

The best guarantee we have of ensuring the health service works is full transparency and accountability, which we do not have in our health service. With the introduction of the HSE the existing levels of accountability were stripped away. We have a serious problem with making the service accountable. Whether in the care of the elderly or medical procedures carried out in Our Lady of Lourdes Hospital in Drogheda, without robust systems in place to ensure accountability, terrible things can be done. Terrible things were done and thanks to media exposure we were all able to see what was happening. While we do not know the full extent, the eminent Professor O'Neill has produced a report that will guide us through to the next stage where we can have the kind of protections and safeguards we all want to have when we are old. Hopefully we will all age and be in the position of vulnerability. Without this report we will not be able to make the progress we need. The Minister has the power to make this report public. We gave her those powers when we enacted the Health Act 2004 and I challenge her to indicate to us why she refuses to use them.

See this speech in context