Dáil debates

Wednesday, 24 January 2007

Health Bill 2006: Second Stage

 

4:00 pm

Photo of Denis NaughtenDenis Naughten (Longford-Roscommon, Fine Gael)

I wish to share time with Deputies Enright and Perry.

I welcome the opportunity to speak on the Bill. Everyone in the country knows what went on in Leas Cross, which was an appalling situation indicative of the great weaknesses in the current system. However, on the other hand there are many good nursing homes at present. We must ensure a high standard in public and private nursing homes throughout the country.

Last Monday's Irish Independent stated that one in five nursing homes failed to administer drugs properly. Two points made in that report were that patients' prescription forms were not being signed by GPs and that drugs were being prescribed over the telephone rather than in writing. I recently came across a situation where an elderly resident of a nursing home, the holder of a medical card, was charged by her GP when he called to visit. That should not happen and provision is made in the nursing home payments scheme that an elderly person should not be charged for such a service. That may be part of the current weakness in nursing homes.

Another big difficulty is that where problems are reported to the existing inspectorate in the HSE, it can sometimes be extremely slow to respond. Certain things stand out in the Bill, for example, an amendment is to be made to the Health Act 2004 to require the HSE to have regard to the new standards set by HIQA when performing its functions. However, the condition is applied that it should happen only where practicable. Second, and more important, it should be subject to the available resources. There is not much point in our setting standards for the HSE and others to follow when it is subject to the available resources. That makes a farce of the legislation when it comes to setting standards.

The Bill also excludes acute hospitals and mental health services, which is a great disappointment. The Minister speaks of the need for quality and safety, something that we all welcome. However, let us reflect on Deputy Twomey's comments on MRSA. The current situation is that elderly people are afraid to enter hospital for basic procedures owing to the risk of contracting it. That is unacceptable. The Bill should cover all hospital services and medical institutions rather than only part of the problem. The Bill sets standards, but they vary by area regarding services, safety, quality, statistical data and information. There must be much more clarity on those issues.

The Government has stated consistently that its priority is to keep people out of nursing homes in the first place so that they can retain their dignity and independence at home. The sad reality is that it is no more than lip service because the elderly are not being provided with such support in their own homes. Let us consider questions that I have tabled here on numerous occasions regarding physiotherapy, occupational therapy, OT, and home help resources. Very little is being said in response to the current backlog, which highlights where the system is falling down.

Older people are being forced into nursing homes because basic health care services are not being provided for them in their communities. The Government has singularly failed to provide the necessary investment to support the elderly in the community. Through the HSE, it has blocked the appointment of staff critical to services at that level. A comprehensive service must be provided for the elderly in the community regarding accommodation, specific services such as OT or physiotherapy, public health nurses and proper support for carers. The cost per annum of supporting a carer in the community is approximately one tenth of paying for a person in a public nursing home and that must be addressed once and for all.

In tandem, we must consider step-down facilities and rehabilitation beds for the elderly. An elderly person in my constituency required physiotherapy for 20 minutes a day in the rehabilitation unit of the Sacred Heart Hospital. That person was told that the only way to get it was to spend 24 hours in a hospital bed at the unit. Despite living only a mile from the hospital, the patient could not be provided with the service at home, being required instead to take up a hospital bed. That is where the system currently falls down.

We have no facility for Alzheimer's or dementia patients in County Roscommon. We are to have one by 2010, but it is already over-subscribed. Yet there are facilities available in Carrick-on-Shannon, County Leitrim, and Ballinasloe, County Galway, to which people who live within a few miles of them in County Roscommon are denied access. It is clear that there are still boundaries when it comes to health services.

There is also the death tax that the Minister is considering introducing, a 15% clawback on property. The Government claims that it is introducing the scheme because many elderly people are currently forced to sell their homes. However, it was the Government that forced through the 5% calculation regarding means before Christmas. Under the new scheme, it is only those patients who are defined as highly dependent who will enjoy access.

What is really sickening about this legislation is that elderly people will now have to pay a death tax, yet there is no clarity regarding how often inspections will take place. It is purely at the discretion of the chief inspector of social services when and how often they occur. Elderly people are paying a premium but not getting a service.

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