Dáil debates
Tuesday, 31 May 2005
Leaders' Questions.
4:00 pm
Enda Kenny (Mayo, Fine Gael)
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Last night's "Prime Time" programme on RTE revealed appalling care of the elderly in the Leas Cross nursing home, Swords, County Dublin. The "Prime Time" crew and Mr. Justice Clarke should be congratulated for looking after the public interest in this serious matter. "Prime Time" exposed a level of degrading and humiliating treatment of vulnerable and elderly people, which should not be tolerated in this or any other society. These people are at everybody's mercy at the end of their days. They built this economy when times were tough and those who featured on the programme last night have paid through the nose for the privilege of being, effectively, tortured.
The majority of nursing homes are run to a high standard but, clearly, a number fall below minimum standards and it is Government's responsibility to ensure high standards are met. Apart from the treatment of the patients in the Leas Cross nursing home, the programme also raised serious questions about the regulation of nursing homes by the Health Service Executive. It is completely and utterly inexcusable that nursing homes should be notified in advance of the date and time of inspections. Deputy O'Dowd has raised these matters for the past seven years and he has encountered a stone wall on every occasion. His file is a foot thick with documents provided following freedom of information requests but it has taken a national television programme to expose the concerns of many people about these matters.
Will the Taoiseach give a guarantee to immediately establish an independent nursing home inspectorate for all nursing homes, voluntary, private and public? Will he give an undertaking that, forthwith, the Health Service Executive will publish all nursing home inspection reports, which should be available free of charge on the Internet? Will he also give an undertaking that nursing homes are adequately staffed and resourced with appropriate professionals?
Bertie Ahern (Dublin Central, Fianna Fail)
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The programme last night uncovered shocking treatment of vulnerable people in the units investigated. No excuse should be offered to defend what happened, as there is no defence for it. It was distressing and upsetting. There was a lack of training, management, supervision and almost everything else in that elderly care unit. On behalf of the Government, I express deep concern with the situation described on "Prime Time" regarding Leas Cross nursing home.
As we have announced, the Government is determined that a new and stronger regulatory system will be put in place so vulnerable people,particularly the elderly, are protected. The relevant Bill to establish the social services inspectorate on a statutory basis to deal with both private and public nursing homes will be published later this year. In answer to questions asked outside the House, the inspectorate will be independent of the HSE. The Department of Health and Children is reviewing the operation of the 1990 and 1993 nursing home Acts to strengthen the powers available to the regulatory authorities. The HSE has been working for considerable time on a national approach to the inspection of nursing homes. This work will be assisted by the fact the HSE is a national agency unlike the old system of health boards.
The Deputy asked me about the reports that will be prepared. The Tánaiste has asked that these reports be made available to relatives or others for examination.
Enda Kenny (Mayo, Fine Gael)
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Does the Taoiseach condemn outright the findings and perpetrators identified in "Prime Time"? I ask the Taoiseach to put an end to announced inspections. The law provides for two inspections of every nursing home each year. There are 423 private nursing homes but only 82 were inspected in 2004, presumably on announcement. Saying this is not known about is not good enough. The Minister of State with responsibility at the time, Deputy Callely——
Jim O'Keeffe (Cork South West, Fine Gael)
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The Minister of State again.
Enda Kenny (Mayo, Fine Gael)
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——wrote about a patient who was sent from a nursing home to Beaumont Hospital. The registrar in question said the following about the patient: "Bad pressure sores, with blistering on the heels and broken skin ulcer, with large excoriated areas on the buttocks, which in my opinion at that time were the worst pressure sores I had seen". A report was sought on this case by the then Minister of State responsible for the elderly.
We know from demographic studies what will happen in terms of numbers. Will the Taoiseach confirm that the nursing homes to which accident and emergency units refer patients under the Tánaiste's new programme have been inspected unannounced and are up to standard? In everyone's interests, will the Taoiseach confirm the ending of the practice of announced inspections of nursing homes? If we saw what was on that programme happening in another country, persons in this House would jump up and down with outrage. I watched the programme again before 8 a.m. and it reminded me of something from the Second World War. The conditions and behaviour were absolutely appalling. The Taoiseach has a chance to do something——
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy has gone a minute over time.
Enda Kenny (Mayo, Fine Gael)
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——about this. I would like him to confirm he will do so in the interests of everybody.
Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy has again asked me to condemn unequivocally what we saw on the programme last night. No excuse can or should be offered for standing over facilities such as that. When one is independently inspecting something, it is bizarre to give warning by ringing ahead. If someone is knowingly or unintentionally acting in such a way in any home, not just Leas Cross, giving notice means what one is doing is not an inspection in a real sense. There should be independent inspections. The inspectorate will be independent of the HSE. Otherwise, the HSE would be referring patients and also examining facilities. The inspectorate must, therefore, be independent.
Specifically in connection with the Leas Cross nursing home, while 21 of the 96 patients were private patients, the home was not one of the newer homes to which people are referred. The HSE has been working for some time on a common national approach to the inspection of nursing homes, which is important. In this way, we have the same benchmark inspection everywhere and standards are crosschecked against acceptable standards.
Seán Ryan (Dublin North, Labour)
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The Government has known about this for four years but has done nothing about it.
Bertie Ahern (Dublin Central, Fianna Fail)
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Hopefully, that will be done.
Jim O'Keeffe (Cork South West, Fine Gael)
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There is nothing new there.
Bertie Ahern (Dublin Central, Fianna Fail)
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I do not know what Deputy Seán Ryan is talking about.
Enda Kenny (Mayo, Fine Gael)
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The Deputy is talking about the accident and emergency contract beds.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to conclude.
Bertie Ahern (Dublin Central, Fianna Fail)
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The patients moving from acute beds are not going to that location. Many people do not wish to be moved. If they did want to, they would be. Following meetings held today, the HSE has agreed that a nurse manager supported by other nursing staff will go to Leas Cross immediately and that a governors board will be established, composed of a geriatrician, a GP and relatives. An inquiry team will examine other relevant issues raised by "Prime Time".
Pat Rabbitte (Dublin South West, Labour)
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Like the Taoiseach and Deputy Kenny, I was shocked. It is shameful for the Government and shameful for our society that what was depicted so graphically last night could happen in modern day society. Private nursing homes are now a part of the health services infrastructure and the new Minister for Health and Children has said they will play a greater role in the future. They are unregulated and operate under the very poor legislation introduced in 1990. Even the minimal standards established therein have been unenforced and general invigilation of standards does not apply.
Will the Taoiseach clarify whether this institution is one of those involved in the Tánaiste's tendering to the private sector for approximately 500 places for step-down care? The Taoiseach opened the home himself, did he not? Are these homes included in the tenders? My colleague, Deputy Burton, submitted an amendment to the Finance Bill to make tax relief arrangements compatible with standards of care and health criteria but it was rejected by the Minister for Finance, Deputy Cowen. Will the Taoiseach rethink his Government's decision not to proceed with the whistleblowers Bill given the relevance of it in this situation and the campaign by the INO to deal with cover ups by giving protection to staff and others? Is the Taoiseach committing to an independent inspectorate? As we know, the Health (Nursing Homes) Act 1990 is insufficient.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's two minutes have concluded.
Pat Rabbitte (Dublin South West, Labour)
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I am just framing my question. Twice in the last three weeks, the Government brought emergency legislation before the House and we enacted all Stages in a matter of hours to save the State money. Surely we can enact legislation before this House rises for the summer recess to deal with this situation.
Liz McManusPat Rabbitte (Dublin South West, Labour)
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Will the Taoiseach commit the Government to doing so?
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Rabbitte asked a number of questions. I will confirm what I told Deputy Kenny earlier, that no beds from the present lot of beds purchased from the private sector were in Leas Cross nursing home. As previously planned, the social services inspectorate will be established on a statutory basis and be independent of the HSE. The Health (Nursing Homes) Act 1990 will be reviewed urgently. Whether it requires amendment will be a matter for the review. The nursing home regulations are also being reviewed.
I opened the Leas Cross nursing home in spring 1998. At that time, it was stated that the home would provide residential care for up to 40 residents with single and double room accommodation that would accord with the policies of the Eastern Health Board and the Department of Health and Children. Obviously, that is now a matter to be examined by the Health Service Executive. Following meetings today with the owner and staff at the home, the HSE has appointed a nurse manager with immediate effect who will be supported by nursing staff. A governance board will be set up and will include a geriatrician, a general practitioner and relatives of the residents. The other matters raised by the "Prime Time" programme will also be examined by the HSE.
Pat Rabbitte (Dublin South West, Labour)
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Will the Taoiseach clarify the position regarding public patients sent to the Leas Cross nursing home and, consequently, subsidised by the State? I understand that patients have been transferred from St. Ita's to this facility. What category of patients was involved in that transfer? Is the State subsidising those patients and were they included in the tender?
Various Ministers are on the record of the House for more than five years making the same commitment as that just made by the Taoiseach regarding an independent inspectorate.
Pat Rabbitte (Dublin South West, Labour)
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The Minister of State, Deputy Seán Power has put short-term measures in place today, namely, the nursing home will operate under new management and professional staff will be put in place. Are any other steps being taken? What, for example, is the purpose of calling in the Garda Síochána and what kind of inquiry is it undertaking?
Does the Taoiseach accept that not only were patients stripped of their normal human dignity but their lives were put at risk? The fact that a patient in the home had MRSA and neither staff nor patients were protected from the spread of that infection is unbelievable.
Bertie Ahern (Dublin Central, Fianna Fail)
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In reply to Deputy Rabbitte's questions, there are 96 patients in the unit, 21 of whom are private. Therefore, most of the people in the home are public patients who are being fully or partially funded by the State. These figures are not the most up to date, but a large proportion — almost 80% — of the residents are public patients.
Deputy Rabbitte is correct in his assertion regarding the commitment——
Seán Ryan (Dublin North, Labour)
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How many patients were moved from St. Ita's?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Seán Ryan is out of order. It is his leader's question.
Bertie Ahern (Dublin Central, Fianna Fail)
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I do not know the answer to Deputy Seán Ryan's question.
The decision on the independent inspectorate was part of the health reform programme. As already announced, the social services inspectorate will be set up on a statutory basis. It has also been announced that it will form part of the health information and standards Bill, which is in preparation. I cannot tell the Deputy at what stage that Bill is, but it is due to be passed this year. It is part of the reform programme. The inspectorate is independent, so all information will be in the public domain.
Residents have been offered the opportunity to move from the home and, strange as it may seem, most of them do not want to according to the HSE. Perhaps they are residents in other units, but they do not want to move and that is why the HSE has put a nurse manager in place immediately.
Paul McGrath (Westmeath, Fine Gael)
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Who will fund that appointment?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Paul McGrath should note that we are dealing with Deputy Rabbitte's question.
Paul McGrath (Westmeath, Fine Gael)
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The question is relevant, however.
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy McGrath is out of order.
Paul McGrath (Westmeath, Fine Gael)
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Why should the taxpayer pay for it?
Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I ask the Deputy to allow the Taoiseach to conclude.
Bertie Ahern (Dublin Central, Fianna Fail)
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As already stated, a governance board will be set up and will include a geriatrician, a general practitioner and relatives of residents. While most people have opted to stay in the home, if some of the public patients wish to move they will be accommodated elsewhere. An inquiry team will examine the other issues raise by the "Prime Time" programme as well as any other relevant issues.
Trevor Sargent (Dublin North, Green Party)
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More often than not, on Tuesday afternoon Leaders' Questions is informed by the RTE's "Prime Time". Once again, the situation revealed by the "Prime Time" investigation has proved to be shocking. Indeed, the shock in north County Dublin is quite palpable given the trust placed in the Leas Cross nursing home by relatives and patients.
The Taoiseach said that the Health Service Executive will conduct an investigation. However, is it not the case that much of the questioning in the House today has focused on the need for an independent inspectorate and investigation? I suggest that the Taoiseach should start as he means to continue, with an independent investigation, in this case, entirely independent of the HSE.
In terms of the standard of nursing home care, will we have a comparable rating with other countries? For example, four hours personal attention per day is considered the norm in the United States whereas here the norm is 2.5 hours. Can the Taoiseach clarify whether the standards will be raised once the investigation is completed? Will regulations governing the sector be tightened up? Certainly, terms such as "adequate staffing" are used as a get-out clause for some people and do not represent proper regulation.
Can the Taoiseach confirm that the Leas Cross nursing home had an ISO accreditation? Given that he was asked to perform the opening ceremony, is it not incumbent on him to satisfy themselves that standards have been complied with so that his is not implicated in any way in the course of an investigation, such as the one about to be carried out? Is there not a lesson here for the Taoiseach and other Ministers to ensure that they are not found wanting when it comes to insisting on high standards?
Bertie Ahern (Dublin Central, Fianna Fail)
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The standards of care are set by geriatricians who design them to achieve the best level of care. That is what takes place in all private nursing homes. While the Health Service Executive does not run this particular home because it is not a public facility, its involvement in examining the issues raised by "Prime Time" is appropriate. In future, the inspector will be independent of the HSE. However, the HSE put in place in the home today appropriate staff and services to deal with the problems highlighted.
I opened the Leas Cross home in 1998 and it was a new building then. It has obviously had a few extensions since then.
Bernard Allen (Cork North Central, Fine Gael)
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Who opened the extensions?
Fergus O'Dowd (Louth, Fine Gael)
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Did G.V. Wright perform the opening ceremonies?
Bertie Ahern (Dublin Central, Fianna Fail)
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At the time of the opening, the home had 30 beds; now it has 90 beds.
The issues were about the management, care provided and maintenance of the home. When the home was opened, it was confirmed that its policies were up to Eastern Health Board and Department of Health and Children standards. Unfortunately, I have not been out there inspecting the standards every day since then, so the Deputy's question does not apply.
Olivia Mitchell (Dublin South, Fine Gael)
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The buck never stops with the Taoiseach.
Bertie Ahern (Dublin Central, Fianna Fail)
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It is important that there is a professional body in place that can inspect facilities on an unannounced basis. That is the only way that we can keep standards to the highest level, keep people on their toes and ensure that standards which are set on the opening of a facility are maintained.
Trevor Sargent (Dublin North, Green Party)
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It is amazing that the Taoiseach does not feel he has any lessons to learn from having opened this facility. It appears that in early May, the Government shelved plans by the former Minister for Health and Children, Deputy Micheál Martin, to develop 850 beds in community nursing units in the east and south as part of a PPP arrangement on the grounds that the plans would have breached the Government's HSE employment ceiling. I wonder whether the former Minister's announcement regarding the 850 beds, a commitment that he later abandoned, was made with the knowledge of the concerns of the Department of Finance.
Is it not the case that this type of tax relief is making a considerable amount of money for some people and that the State is effectively abdicating responsibility for ensuring standards are maintained and people are treated with dignity? Is it not the case that one of the reasons for such lax enforcement of standards is that there is no spare capacity if an inspector goes into a nursing home and decides that it must be closed? In many cases, there is nowhere for patients from substandard nursing homes to go. The Taoiseach mentioned that patients at the nursing home featured in the "Prime Time" programme did not want to leave it but surely this is not the point. The point should be that if a nursing home must be closed down there should not be the option for people to stay put. One of the reasons places like this are not closed down is that the State has not provided for the spare capacity to allow such a decision to be made.
Bertie Ahern (Dublin Central, Fianna Fail)
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Standards can slip in both public and private nursing homes.
Bertie Ahern (Dublin Central, Fianna Fail)
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I hope staff in these nursing homes feel they have an obligation to maintain high standards. If people work in places that are substandard or where treatment does not adhere to high standards, it is an issue for them.
Bernard Allen (Cork North Central, Fine Gael)
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It is a cop out; blame the staff.
Bertie Ahern (Dublin Central, Fianna Fail)
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It is not self-assessment but there are responsibilities. Every day, people who work in these institutions report issues relating to standards to their superiors.
Bernard Allen (Cork North Central, Fine Gael)
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They would be out the door by 6 o'clock.
Bertie Ahern (Dublin Central, Fianna Fail)
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They would not be out the door by 6 o'clock.
Bernard Allen (Cork North Central, Fine Gael)
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It is a cop out.
Bertie Ahern (Dublin Central, Fianna Fail)
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There are many nursing homes that adhere to the highest standards, as has been stated earlier on. For some years, the social services inspectorate has stated that it should be put on a statutory basis. Health board checks on nursing homes have been carried out since the 1990 Act. There has been a legislative basis for these checks for the past 15 years. Deputy Kenny stated that two inspections are carried out every year. There are more inspections where health board officials have particular concerns about a home or where it is housed in an older building. It is better to examine matters like this in the round. It has been long announced that the social services inspectorate will be established as an independent agency on a statutory basis. We will examine the Health (Nursing Homes) Act 1990 and the regulations to see if they improve the situation and will seek to end the regrettable practice of informing nursing homes that they will be inspected.