Olwyn Enright (Laois-Offaly, Fine Gael)

I too welcome the opportunity to speak on this legislation. I wish to stick as far as possible to the Bill itself, but before continuing further I will say a few words on MRSA. No one suggests that it will be simple to fight it, but it cannot be ignored.

I will relate an experience that I had when visiting a patient in a hospital on the south side of Dublin the week before last. When I entered, there were yellow and orange neon signs absolutely everywhere to the effect that one should not enter and that only urgent family visits should be undertaken owing to the risk of MRSA. People all around me were walking in and out of the hospital and they were clearly visitors rather than patients. I went to the reception desk and asked whether it was all right for me to visit the patient in light of the signs. I was told that it was up to me. I asked whether I should visit the gentleman in question but was again told that it was up to me. Eventually I asked whether the signs were there for my benefit or that of the patients in the hospital, and all I got in reply was a shrug of the shoulders.

There either was or was not an MRSA outbreak in the hospital at the time. If there was one, we should quite clearly not have been allowed in. It cannot be left up to individual members of the public whether to enter; we either can or we cannot do so. The hospital should have such basic matters under its control, with extremely clear rules in that regard. I support Deputy Twomey in his views on the proposals contained in the Bill, which do not adequately deal with the issue.

The legislation is late and is a lethargic response to what can only be described as criminal abuse of the elderly in our community. Leas Cross was disgusting and I am sure the Minister for Health and Children feels the same way. We have seen and heard appalling stories about a few nursing homes, representing a degradation of these elderly people's human rights. We hope that nursing homes such as Leas Cross are a tiny minority but we do not know for certain that is the case. We rely on anecdotal information and people must base their opinion on nursing homes with which they have had dealings. We need far more information on operations and standards.

Perhaps the Minister has not accessed the inspection reports on the HSE website recently. I seek an explanation why there are no inspection reports for the two private nursing homes in County Laois. Only three reports have been published for nursing homes in County Offaly. I have read all three closely but they do not refer to care received in the nursing home. The report focusses on the physical state of the building. Although that is important because accidents can happen if the building is not in good condition, the crucial matter is the level of care received. On the last page of all three reports, after the inspectors have signed off, it is stated that no medical officer was available to assist with the reports. The three reports on nursing homes in Offaly were based on physical state of the buildings. Families can see if a light bulb is missing but it is more difficult to determine the standard of care being received.

I am disappointed that the legislation does not outline the standards to be applied. Will regular, unannounced inspections be compulsory? People should be able to evaluate nursing homes before they or a family member enter the home. Owners of nursing homes should have nothing to fear. If the home is properly run, its name should be up in lights. The standard of care is the most important issue.

A study by Dr. Shaun T. O'Keeffe and Dr. Jean Murphy was carried out on the frequency and appropriateness of prescribing anti-psychotic drugs to older people in long stay institutions. The study found inappropriate prescribing in more than 50% of cases. The patients exhibited behaviour common in those who suffer from dementia, including wandering, anxiety, shouting, spitting, restlessness, fidgeting and nervousness but they were given anti-psychotic drugs. This was a more common occurrence in private institutions than public institutions. The study also found that those residing in public institutions had a greater level of specialist care. In the United States the Omnibus Budget Reconciliation Act 1987 deals with such matter. Ireland has no such legislation. Before it was enacted in the United States the levels of inappropriate prescribing were similar to those in Ireland at present and have improved since then. The study does not recommend that the legislation be enacted in Ireland but that guidelines be introduced. It also suggests better education for medical and nursing staff about prescribing and improved access to specialised geriatric services. This is particularly important in private institutions.

I am disappointed there is no advocacy role given to patients under this Bill. Patients are among the most vulnerable people in society and are entitled to a voice. If patients attempt to make a complaint they face a daunting process that is not designed to meet their needs. Everyone else in the system can rely on an employer, insurance or a union to provide support. The patient is the only one without a voice.

The Bill does not address home help and home care packages. The vast majority providing this service are inadequately, if at all, supervised and are not vetted to ensure they are suitable. These people provide a service to elderly, vulnerable people, most of whom are home alone at the time.

The HSE must play a role in providing community care facilities. My home town is an example of an extremely good facility but the HSE is slow to provide more. In 1997 a 20-bed extension was approved for Riada House in Tullamore. A block has not yet been laid ten years later but already a greater number of beds is needed. At meetings with the HSE I have asked what will happen to the old Tullamore General Hospital when the new facility is built. It would be ideal to provide step down facilities at the old location. I fear more offices will be put there, which is not acceptable.

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