Seán Ryan (Dublin North, Labour)

I am pleased to have this opportunity to make a contribution on the need to establish a patient safety authority and to put patient safety at the centre of our health service. Unfortunately to date, this has not been the case.

In recent times there has been a litany of shocking revelations about deficiencies in our health service to such an extent that public confidence in it has been undermined. In the short time at my disposal I wish to address the litany of revelations in respect of Leas Cross.

The Leas Cross report, which had to be dragged out of the Department of Health and Children and the Health Service Executive, is one of the most damning reports in the history of this State. The Government, the health boards and the medical profession must be condemned for the systematic failure that led to the mistreatment of elderly people in the Leas Cross nursing home. The most startling aspect of this shameful episode is that the Government and authorities could and should have intervened earlier to have the Leas Cross nursing home investigated and closed.

I will elaborate on why I say that. In 1994, well before the "Prime Time Investigates" programme on Leas Cross, a range of problems were identified by the inadequate inspectorate system, which we now have in place, and brought to the attention of the Department of Health and Children and the health boards regarding the deficiencies in nursing care in nursing homes not only in Leas Cross but throughout the length and breadth of the country. The range of problems identified at that time included staffing levels and nursing policy issues, maintenance and accommodation standards, hygiene problems, lack of incentives for residents, poor record keeping, insufficient or no active involvement from the local authorities on fire safety issues, lack of equipment and appropriate clinical practices, for example a lack of pressure mattresses, and discrepancy in the contract of care. These issues were well known to the Minister and her junior Ministers with responsibilities in this area.

I am aware of a submission to Professor O'Neill in respect of the death of a 91 year old relative of a constituent of mine, who first entered Leas Cross in December 2002 and who died in 2004. Among the issues raised were: the patient was injured and knocked to the floor on numerous occasions; the 91 year old man lay in bed for three days with a broken hip before being seen by a doctor; when he was eventually brought to Beaumont Hospital the doctor who admitted him said this elderly man was suffering from malnutrition when he arrived in the hospital; and his death certificate was not registered as required. All these issues were raised with the health board at the time.

Over the years I have raised with the senior officials of the health boards the policy of transferring residents from the loving homely environment in St. Ita's to private nursing homes and I question the criteria, need and justification for this policy. After reading Professor O'Neill's report, it is obvious the care of the residents of St. Ita's who were transferred was not the main priority. There was another agenda — senior management had to be seen to implement a policy of moving patients from St. Ita's, irrespective of the consequences.

People with intellectual disabilities have no one to speak for them and therefore it is important that I place on record some of the facts that were brought to the attention of the officials of the health board as far back as 2003. If the officials of the health board knew about them, the officials of the Department of Health and Children also knew about them. A consultant in old age psychiatry raised the need to follow up patients transferred from St. Ita's Hospital to Leas Cross. A further letter, within two weeks, from two senior consultants also referred to a need for follow up services. They particularly drew attention to the fact that three of the initial group of 14 patients discharged to Leas Cross had been referred fairly quickly to Beaumont Hospital as being seriously ill. Nursing care appeared to have been the issue in all these cases. The last two patients had arrived with bronchial pneumonia and one was suffering from dehydration. These concerns were brought to the attention of the director of the nursing home inspectorate team on 9 January 2004. These consultants also pointed out that seven deaths had occurred since the transfer of the patients on 3 September, and three of them occurred over the Christmas period. This damning letter was circulated to everyone within the system and we are told that nobody knew anything about it and nobody was responsible.

Professor O'Neill's report states that a memo exists of issues discussed with the director of nursing of Leas Cross following a visit to Leas Cross nursing home in July 2004. The consultant highlighted the main concern was lack of qualified staff, auxiliary staff and basic nursing care to meet patients' needs. She also noted a lack of stimulation, occupational therapy and supervision. Four of the former St. Ita's patients — many of whom I knew to see because I live in Portrane and I used to visit patients there who were cared for in a loving, caring environment — were sitting in wheelchairs and others in old Buxton chairs. Generally, personal hygiene was poor. That was never the case in St. Ita's where these patients were looked after and minded for years. Clothes were grubby in appearance and a few patients had a strong odour of incontinence. Staffing appeared inadequate with only one qualified staff nurse and nine care staff caring for 65 residents in one area and one qualified staff nurse and four attendants for approximately 40 residents in another area. These concerns were also expressed to many of the senior people in the Department and the health boards.

A further matter of concern raised by the consultant psychiatrist was that the group with dementia as a primary diagnosis had a high mortality rate in Leas Cross. The admissions that were transferred to hospitals were characterised as suffering from dehydration, pneumonia and skin care problems raising concerns over adequacy of care. I could go on and list further concerns.

This is the reality of lack of care and attention given to some of the most vulnerable people in our society. We are charged with looking out for those people and Ministers and officials in the health boards have responsibility for the care of people with intellectual disability. What were they doing in arranging for these patients to be taken out of hospital and put into a nursing home, knowing what was going on? Did they do anything about it? No, they kept their heads down.

What are we told about this report? Nobody is responsible and nobody is prepared to put up their hands and say there was a mistake, there was an error.

It is painfully obvious that the Minister, the Department and the health boards simply turned a blind eye to these problems and as a result elderly people and people with intellectual disabilities, who are among the most vulnerable in our society, suffered appalling conditions and treatment in Leas Cross. This is an indictment of the failure of the Government's policy in this area over the years. We do not have a clear and transparent set of rights and entitlements for older people and their families. We do not have a system which ensures quality care is delivered. We do not have a fair and equitable system for financing care. With all the money available to it, this Government failed in its commitment to provide 800 public nursing home beds for the most vulnerable in our society. In my area of north Dublin people in need of public nursing homes will be dead years before their time. It is up to the Government to take responsibility and look after the most vulnerable in our society.

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