Cecilia Keaveney (Donegal North East, Fianna Fail)

I am sad we have reached a day where we must bring in a Bill that deals with inspections of nursing homes. Of course, everybody needs to be brought up to important standards which need to be maintained. I suppose it is the background to the Bill, where some people have been exposed to treatment they should not have been exposed to, that makes me sad. We all have an interest in this because none of us is getting younger. It is always said that one should look after one's children and grandchildren because they will choose one's nursing home. In this context, the Bill is relevant to everybody in the House and I am glad it has had such a long airing on Second Stage.

No one can stand over those tragic situations where, for whatever reason, people felt they could treat older people with anything less than respect and dignity. It might be naive to say so, but I am confident in saying that in my constituency people still put a very high value on the level of care for the elderly. I like to think that when the inspection teams visit institutions in my constituency, they will pass with flying colours. I like to think that humanity in Ireland has not sunk so far and that the cases highlighted are far from the norm.

Having said that, I was recently asked what I thought about on-farm cross-compliance inspections, which led me to think about how in nearly every walk of life, be it in education in schools or farming, there are established inspection services. When one is talking about the most vulnerable people, namely, sick elderly people, there is no need to explain why they should be embraced by an inspection process.

This Bill deals with foster care and private and public nursing homes. I like to think the audits that have begun, namely, the hygiene audits in public and, I assume, private hospitals, will also get a focus, although possibly not under this Bill. I hope these audits will always remain independent and that people will continue to ensure we always strive to achieve the highest form of cleanliness, not only in our nursing homes and those types of institutions, but also in our hospitals because we know the impact of MRSA. A group in Donegal is working very hard to continue lobbying people so they are aware that when they visit hospitals they are potentially bringing in bacteria or their actions can spread bacteria. We all have a role to play in letting people know that our actions and inaction in terms of simple matters like washing our hands can have a big impact on people who are already vulnerable because of the illnesses they have in our hospitals.

There has been much investment in hospitals. In my area, Letterkenny General Hospital is moving from innovation to innovation. It has been under a certain amount of pressure, but I am glad that in terms of beds, a 30-bed modular unit is ready to roll in March and the bigger project has gone through planning. I am glad to see this happening because there have been pressures there but the nursing staff in particular have been coping and deserve the easing of this pressure.

I am also glad there has again been confirmation this week that the Government has moved in respect of the permanent breast surgeon who will be based in Letterkenny. It is part of the overall striving to ensure that when people are in hospital, they are treated to the best possible level and, particularly in respect of breast cancer, can have their surgery in a safe local environment. I do not believe we should just have a local service. The service should be of the highest value to the patient because one does not want to have any old level of service provided locally. Ultimately, if one is sick, one wants the best possible chance of survival.

The task of finding a partner for Letterkenny General Hospital was slow and arduous. The choice of University College Hospital Galway has led to new and important opportunities. I am pleased to see BreastCheck is still on target for the end of 2007. I also look forward to the development of the satellite service, whether it is out of Belfast or Galway. I welcome the fact that patients from Donegal with breast surgery issues have three choices, in Belfast, Galway and Dublin. It is an indication that things have moved on. Progress is evident also in the extension of the NowDoc service as a cross-Border one. This is an indication of the ongoing improvement in cross-Border co-operation. For example, there is co-operation on ENT and dermatology services between Letterkenny and Altnagelvin hospitals.

Cross-Border co-operation makes sense. The current level of co-operation could result in patients going to nursing homes in another jurisdiction, depending on their location. I would welcome an indication of whether talks are ongoing between the HSE and its equivalent in the Six Counties to ensure some level of integration between the two services so that reports and inspections can be carried out on a north-west region basis rather than a North-South basis.

I referred to the extra beds, services and supports being provided for such hospitals as Letterkenny and the need for hygiene audits to continue and be independent. Patients and visitors alike must be made aware of the role they have to play in continuing to ensure they do not spread germs when they go into hospitals in Letterkenny, Buncrana and Carndonagh.

People who are ill prefer to be at home if that is possible. I welcome the Bill in that context. A number of people have offered their homes to look after elderly people. In the main these are high quality locations for patients but it is important for them to be checked because support may be required for people in terms of home care packages either in the patient's own home or this type of half-way house and it is important that inspectors would be able to pick up on this at first hand as well as be in a position to suggest the use of best practice models from elsewhere.

The home care packages provided by the Minister, Deputy Harney, are only beginning to take effect and there is still a long way to go in this regard. In my constituency the district hospital tends to hold on to patients for a long time. In many cases, families would prefer their relative to be in the district hospital than for them to move home or to a nursing home. As a result, nursing homes are not as prevalent in some rural areas as in other places because district hospitals are still seen as step-down facilities and many people continue to remain there even when the medical need is less acute and could possibly be dealt with elsewhere. That said, district hospitals provide an important service. The provision of adequate home care packages are the best way to ensure the step-down from district hospitals into the community.

Voluntary housing schemes have delivered many housing units in rural areas. A number of them operate in my constituency. These schemes primarily cater for elderly people. They are not nursing homes. They provide a home from home for elderly people. While capital funding is provided, these schemes also need social capital. We should focus on the personnel involved. Such homes are not registered as nursing homes. They are voluntary housing schemes for elderly people provided under the aegis of the Department of the Environment, Heritage and Local Government. Education may be necessary for staff working in these homes with the elderly. Public nursing care is another aspect that must be considered. I would not advocate that such centres would be registered as nursing homes; I would prefer the focus to be on the provision of home care packages, which provide a home environment for people who can no longer live at home. The Department of the Environment, Heritage and Local Government and the HSE should link up on this matter.

The Alzheimer's unit in Carndonagh will be of great benefit to the community as it will provide help for families who have difficulty dealing with patients but it will also offer advice and a listening ear service for families who do not wish to institutionalise their relatives.

I wish to refer to the sad death featured on the front page of many newspapers today — Deputy Deasy referred to this case earlier. We are very saddened any time a young person loses his or her life. Having read the HSE statement, it is clear Deputy Deasy and the HSE place a different emphasis on what happened and, more importantly, what should have happened. Professionals within agencies, be it the HSE, the Garda Síochána or the justice system, make decisions based on recommendations. Every case is individual and the circumstances are specific to each one. I read that in this instance the HSE confirmed that residential care was not ruled out.

All professionals agree, whether in terms of young people or the elderly, that people do best when they remain at home. If young people are at home with parents they have the best chance of recovery. If that is not possible, the next best option is to be in another home in a family environment or similar. Of the 5,000 children in care in Ireland, 90% are currently in foster care. In the case highlighted today it is important that we await the results of the review when it is completed, pass judgment at that point and learn from any mistakes that may have been made. I do not wish to pre-empt the outcome of the review. Great people in my constituency have taken on foster children, some of whom can be quite difficult. I welcome the Government's continued recognition of the valuable work done by these families and the increase in the support mechanisms provided for them. We should never forget the invaluable work done by people who become foster carers.

I also welcome the budget increase in nursing home subventions. There are a number of public and private nursing homes in my area. It was a big shock when one of them increased its rates by €250 per week recently. When I hear of the charges for nursing homes in Dublin and elsewhere I wonder how nursing homes in Donegal survive on what they charge. The increase in subvention has enabled the nursing home in question to increase its charges, which had not been increased in five years. I do not know how they have survived. In the north west people have tried to keep family members at home for longer and by the time they get to nursing homes they are much older. The average age at which they enter nursing homes in my area is 80 plus and, therefore, they have greater medical needs. I congratulate those who have been able to keep people at home and I know people want to remain at home. This Bill is about ensuring that when they are at home there will be inspections and that they will be looked after properly and that if they have to go into a nursing home they will receive appropriate and proper care.

I have already referred to the support for district hospitals because I believe the nurses there do tremendous work. While there is a dispute concerning the 39 hour and the 35 hour week I hope it can be resolved through dialogue and without resorting to industrial action. In our communities we all know the nurses and the last thing one wants is industrial action. I hope the ongoing talks will result in a successful conclusion.

I want to include a spoke for my report on music therapy which I published in September. We are speaking about extra care in nursing homes and trying to ensure people's quality of life is maintained. From the perspective of mental health, there was a major debate in the media yesterday and today on A Vision for Change and on introducing new creative therapies into the multi-disciplinary approach to mental health. In my report I prove that music therapy must be central to that multi-disciplinary approach, yet we have not defined it as a profession and, therefore, it cannot be paid for as a professional grade. I ask the Minister, the Minister of State and the HSE to continue to try to have music therapists recognised, as they are everywhere else, including Northern Ireland, on a par with physiotherapists, occupational therapists and speech therapists. There is no point in us touching our cap to A Vision for Change and saying we want multi-disciplinary approaches when one of its most effective aspects, the creative therapies, is being ignored. I will continue this battle until it happens as I have got to the stage where I really believe in it. The proof is all around us.

Whether one is young and autistic or has suffered a trauma and cannot or will not speak, is a parent of a toddler with whom one has not bonded, an Alzheimer's patient or an elderly person with communication difficulties, music therapy has a role to play. That is central to the people we are talking about, those who want a better quality of life and want the Government to intervene in the provision of new and creative approaches to improve their quality of life. That is not unique to Europe but is central to many European countries' provision of care.

Much has been said recently about rural access to pubs. Rural people want not only access to pubs but to be able to collect their pension and go shopping and on hospital visits, but in many cases there is no rural transport. That the EU has sanctioned the pilot rural transport initiative as a national transport service is welcome. The issue of access to hospitals should be central to any discussion on the rural transport initiative. Ultimately Action Inishowen and the wheelchair bus from the disability sector in Inishowen is providing a service for patients. It is important to realise that rural transport should not begin and end at the pub and it should not be the central focus of rural transport because there is much more to rural life than going to and from pubs.

The message about the National Treatment Purchase Fund is not getting out. People still say they have been told of a waiting list of a year or 18 months for hip and knee operations. I do not know how the HSE can get the message out any clearer but if people have a medical need perhaps this is an area in which the inspectorate has a role. Given that one can self-refer or the general practitioner can refer a person to the National Treatment Purchase Fund, it is important that message is got out through the media and general practitioners. I am concerned that, many months later, people still believe there is more than a three-month waiting list for operations. The Government has been proactive in this area and has been successful.

I wish the Bill well. I hope it is a matter of saying, "well done, good and faithful servants", to those whom people visit, but I realise the Bill is needed at this time to ensure there are quality standards for everyone in this House as we get older.

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