Wednesday, 1 June 2005
Yesterday, following the "Prime Time" programme, the focus of attention was on the Leas Cross nursing home and the need to tackle the systematic and grossly unacceptable practices in place there. However, the issues raised by the television programme are of much wider import and relate to the abuse of elderly people in general.
This Government has failed elderly citizens. It has presided over a hopeless inspection regime that gives advance notice of inspection and does not carry out the minimum number of inspections required by law. Only 80 private nursing homes were inspected once last year; over 480 homes should have been inspected twice. The inspection regime does not have the power to close nursing homes where standards are inadequate and it allowed the Leas Cross scandal to happen. That scandal, by implication, drags down the reputation of all nursing homes, some of which have exceptionally high standards and provide excellent nursing care.
Responsibility for the inadequate regime lies with the Taoiseach and his Government. Promises were made in 2001 to introduce legislation to deal with this matter. Promises were also made to implement recommendations on elderly abuse. These promises have not been fulfilled.
Is the Taoiseach prepared to introduce legislation for a new, independent inspectorate in the coming weeks? Last December, the Tánaiste rushed through legislation to deal with illegal charges for long-stay beds. The Government should show the same urgency in drafting legislation to protect elderly people as it did in attempting to take 80% of their pension payments. Members on this side of the House will facilitate the Government in ensuring that the Bill is introduced and passed before the summer recess.
In view of the appalling inadequacy of the inspection regime, has the Taoiseach called in the Health Services Executive to ascertain on whose instructions advance notice of inspection was, and is, given to all nursing homes? That is akin to giving the question papers to next week's leaving certificate students. It is a complete failure of this Government to have introduced an inspection regime that is utterly inadequate. It is a further failure that it takes a programme like "Prime Time" to expose a scandal in a particular nursing home. There is evidence that the problems exposed may exist in a number of other nursing homes.
This Government takes the issues relating to the elderly most seriously, including carers, home help, housing, respite care and many other areas. We have shown our concern by our actions throughout our term in office and we will show it again in dealing with this case.
As I said yesterday, what happened at Leas Cross nursing home was unacceptable and was an insult to the residents and their families. It cannot happen again. Agreement has been reached between the HSE and the home that will bring about much needed improvements immediately. The Minister of State at the Department of Health and Children with responsibility for the elderly, Deputy Seán Power, met the HSE yesterday and arranged for a report to be drawn up on the position in the home. The changes that were agreed will be examined in a month's time to assess their implementation. Efforts will continue to ensure that care at the home is up to the proper standard.
I spoke to the HSE and Deputy Seán Power about the issues. The problem in the Leas Cross case was not a lack of inspections. There are ten inspectoral teams, based on the old health board system. That will be changed under the reform proposals introduced by the Tánaiste. There was no conformity in the inspection procedure and the HSE is now working to introduce a unified approach and to develop a robust inspection system that will be able to deal with difficulties in a unified fashion across the country.
The HSE is already doing it.
It will be made up of teams of medical, nursing and environmental inspectors. As Deputy Kenny pointed out, there are inspections taking place in health board areas already. The strongest inspectorate, because it is a dedicated unit, is in the former Northern Health Board area, where the Leas Cross home is located. The inspectorate had been dealing with the home and thought it was making progress. It probably was making progress in many areas — I do not want to be critical of the staff who were acting in good faith. Inspectorate staff highlighted issues and asked that problems be rectified. Clearly they were not rectified and that was appalling, as I stated yesterday. Legislation to establish a proper inspectorate that will be independent of the HSE and deal with both nursing homes and children is being prepared. The legislation will not be ready before the summer but will be introduced in the autumn. That will not stop the work going on between now and the autumn.
I asked why nursing homes are given advance notice of inspections. In most cases, nursing homes are not given advance notice. However, advance notice is given of the first call to the institution. This is because inspectors wish to talk to the managers and owners of the home. They do not give advance notice because they just want to inspect the building. They want to inspect the insurance, fire certificate, the accounts and all of the other relevant issues. On subsequent visits——
When inspectors come back on subsequent visits, they do not give notice. They come back to inspect the wards and medical facilities but there is little point in them turning up to check all the other issues when there is nobody there. This is the reason why they operate the system they do.
The HSE also meets the nursing home association and works with it to improve standards. The HSE works with public nursing homes to ensure standards in them are improved because we readily admit there are problems to be rectified. The Health (Nursing Homes) Act 1990 and the 1993 regulations are being reviewed.
He has not answered any question and it is typical of his governance that while he is more interested in ticking boxes and defending the inadequacy of the HSE by saying it does not give advance notice of inspections, 80 nursing homes were inspected once in 2004, when the legal requirement is two inspections per year of 480 private nursing homes. The Taoiseach's answer is disgraceful.
The Government took a case against Rostrevor Nursing Home to close it in 2004. That case has been dropped. Why was the HSE not sent into this nursing home to do what it is doing in Leas Cross? Will Leas Cross be run by the HSE while still having the benefit of patients paying €45,000 or €46,000 per year when serious repayments were made to the Revenue Commissioners by the owners? If inspections of the nursing home were carried out, how did this situation come about?
Is the Taoiseach prepared to confirm that there will be no further notice given of inspections? Is he prepared to say he will introduce legislation before the summer, which this side of the House will facilitate, to protect elderly people? The current demographics of the country mean we are facing a crisis in the next 20 years in this area. Is he prepared to deal with the case of Rostrevor Nursing Home and others in the same way as Leas Cross is being dealt with? Will he point out who gets the benefit of the profits from the patients of Leas Cross who pay €46,000 per year for systematic abuse in a number of cases that were portrayed in "Prime Time Investigates"? This is a disgrace and it concerns governance by this Government, which has failed utterly to deal with the comfort, consolation and care of our elderly citizens, of whom we should be so proud but for whom we have shown such utter and appalling neglect in this case.
This neglect is typified by the launch this morning by the Tánaiste and Minister for Health and Children of a document entitled No One has the Right: National Conference on Elderly Abuse. This conference was held on 25 November 2004 but the Government suddenly decided to launch the document today. The Government has thrown its hat at it and the public will answer it in due course.
Deputy Kenny could at least get his facts right as the report was launched by the organisation. I said yesterday that the conditions in Leas Cross Nursing Home are unacceptable and I have said it again today. The agreement reached yesterday between the Health Service Executive and the nursing home to bring about much needed improvement will be paid for by the nursing home and not the State. The HSE has dictated what needs to be done and what is being done. I said the governance of the nursing home will also be significantly changed. A clinical governance steering committee, with representatives of residents, residents' families and an independent expert, will be established. I said the Minister for State at the Department for Health and Children met the HSE yesterday to discuss the matter and will meet it again in a month to ensure that what was agreed at yesterday's meeting will be implemented. I said inspections had taken place and that the North Eastern Health Board was visiting this home. Inspections were carried out both with and without notice. It believed in good faith that the management of Leas Cross was carrying out the measures the inspectors had highlighted. They have now discovered the management did not undertake these measures and feel disappointed and let down.
Deputy Kenny asked two questions at the outset and said I gave a cynical answer when I answered both questions. He asked me whether legislation would be introduced before the summer and I said it would not but would be introduced in the autumn. I said that the proposed inspectorate will cover all areas. He asked me why advance notice of inspections is given to nursing homes and I explained the reason to him. I said that when inspectors visit the home for the first time to give it its three-year registration, they ask to examine all the issues, including accounts, staffing levels, insurance and the fire certificate.
When inspectors return for subsequent visits to look at patients and organisation, they do not give notice. If they are not satisfied, under existing legislative powers, inspectors do not try to close units but try to get them to conform to the highest standards, as they do in public nursing homes.
Staffing levels in public nursing homes are composed of both medical and clinical care and inspectors try to enforce those. If they believe either from an infrastructural or medical perspective, a nursing home is not up to the proper standards, they have no alternative but to move to close it.
In many cases, the nursing home is the home for the individual so the HSE attempts to ensure homes have the highest standards so people are not disrupted. If the home does not comply with the HSE's stipulations, the HSE moves to close the home.
I do not mind but I note it is 10.50 a.m. I refer to a letter the Tánaiste and Minister for Health and Children wrote to my colleague, Deputy Seán Ryan, on 1 December 2004 which said "I am satisfied the nursing home regulations are being implemented properly".
She continued, "A range of problems are being identified by the inspectors of private nursing homes and these include staffing levels and nursing policy issues, maintenance of accommodation standards, hygiene problems, lack of activities for residents, poor record keeping, insufficient or no active involvement from the local authority in fire safety, lack of equipment appropriate to clinical practice, for example, pressure mattresses, etc". She goes on to explain the problems, having said that she is satisfied that the regulations are being implemented properly. This can only mean the regulations are woefully inadequate, based on an Act the Ceann Comhairle introduced in 1990 when he was Minister for Health. I want to put the question the Taoiseach avoided in responding to Deputy Kenny. Will he legislate on this matter before the House rises? Twice in the past three weeks he rushed emergency legislation through this House to save the State money and now he is humming and hawing about when he will legislate on an issue that is so pressing for some of our more vulnerable citizens.
The Taoiseach, in his remark to Deputy Kenny in respect of the HSE, stated they thought they were making progress with the operator. Can I ask him about that in the case of Mr. Peter McKenna, who featured in the programme and with whose family my office has been working over a period to deal with the circumstances that he confronted and that were shown on that programme? He died in awful and painful circumstances, which I will not describe, in Leas Cross. Following continued and persistent pressure from my office, Mr. Martin Hynes, former chief executive of the Irish Blood Transfusion Service, was brought in to investigate the McKenna case. Mr. Hynes reported a couple of months ago. How can the Taoiseach say the HSE thought it was solving these problems and how can the HSE go on television and state that it was as shocked as the rest of us and taken by surprise at the extent of the problems portrayed at Leas Cross? How can they say that when they have the Hynes report, which has not been put into the public domain? Surely they knew. Former civil servants are careful and use euphemistic language, as we know from recent events. When dealing with a Government permanently in office, they take great care to be understated. I know the Taoiseach has a bad record in inspections in north Dublin but surely this defies explanation.
The Tánaiste and Minister for Health and Children announced some time ago that both the 1990 legislation and the 1993 regulations were being reviewed. They are being reviewed as part of the process that leads to this legislation, as I answered yesterday. Obviously, the reason they are being reviewed is they are not considered adequate.
The HSE is only in existence since 1 January but prior to that time there were ten inspectorate teams. They did not have conformity or a unified system. Since 1 January the HSE has been unifying the systems, trying to have a more robust organisation that will conduct far more vigorous inspections than at present. Under the current system, certainly since the 1990 Act and the 1993 regulations, they try to work with the management of the various institutions to bring them up to the standards they demand. I understand the Northern Area Health Board had problems, complaints and issues with the management and staff of Leas Cross. It believed it was making progress in getting these rectified. Staff now believe they were duped. That is their position and that is what they have said to me. They believe that what they were told on these issues was not being followed through and the systematic abuses we saw the other night were issues that they did not think happened. The reason for this is that they were not their 24 hours a day. The staffing levels were not what they thought. The standards were not what they thought. At times, obviously they were adequate but at other times they were wholly inadequate. That means we need a far more robust organisation with more detailed inspections. That will obviously mean, in time, more staff. It will mean a new inspectorate that will be probably far more vigilant than has been the case in the past. That is a fact.
In answer to Deputy Rabbitte, I am not tooing and froing. I have answered twice already that the legislation will be published in the autumn.
The legislation is being prepared. It is legislation which will include inspectorates for a range of areas, not just nursing homes. That is under way.
I do not have details or knowledge about the case to which the Deputy referred but I imagine there are other cases too. The reality is that while there is an inspectorate, it should fully cover medical, nursing and environmental inspectors. It does but it has not sufficient presence. That was clear from the programme and from complaints like the one to which the Deputy referred.
The lesson from this is that we need stronger legislation. As we all know, stronger legislation, if not implemented, means nothing. Really what we need is an inspectorate that has conformity, that is unified, that conducts more inspections and that obviously will have more staff without which it could not do the work. In the meantime, the current regulations allow for many of these matters anyway. The HSE is determined over the period ahead, not only with Leas Cross but with some others it has mentioned, to work with the individuals and the nursing home association to try to get action. That is the truthful and honest position.
I ask the Taoiseach to make himself aware of the Peter McKenna case. I think he will be as appalled as I am at what happened. I ask him to commit to the publication of the report by Mr. Martin Hynes. That report was in the possession of the people who are now proclaiming to be shocked. To state that we were duped on the supervision and invigilation of nursing homes is not exactly much of a defence.
Can I raise with the Taoiseach his assertion to Deputy Kenny that he has done so much for old people? He instanced carer's allowance and home help. The committee chaired by my colleague, Deputy Penrose, which reported on 27 November 2003 and which was subscribed to and signed up to by the Taoiseach's Deputies, recommended the abolition of the means testing for carer's allowance. This would provide the opportunity for more people to be cared for in their own homes, which is their preference. There has been no response from the Government on that issue.
The Taoiseach instanced the case of home help. Is he aware that the hours of home help are being cut in different parts of the country? Is he aware, for example, that when the people who perform the home help service had to be paid the minimum rate, what the health boards did was reduce the hours? They paid them the statutory minimum rate. Because they were women and because they were doing "menial work", which is a terrible description of the invaluable service they provide, they were paid buttons. Now they are paid the minimum rate and the Government cut the hours. For example, there is a 40% cut in north Kildare and a 20% cut in south Kildare. I have figures for different parts of the country. That is what is happening in Celtic tiger Ireland and at the same time, the Taoiseach is telling Deputy Kenny to look at what he did on home help and carer's allowance.
Unless there is some legal or privacy issue of which I am not aware, I will check the report by Mr. Martin Hynes and make myself aware of the case.
There have been substantial improvements in the carer's allowance in every year of this Government.
In reply to Deputy Rabbitte, from today a new respite grant is payable, regardless of means, to 33,000 people who are carers, which will be very beneficial and of significant help.
As I stated, the Government is determined on this issue. On home help, the Deputy is correct in stating that people were paid a pittance. We now pay €115 million to people.
There are two central issues in this regard. First, we must try to achieve conformity of our systems, better inspections and, under the existing legislation, make as much progress in this regard as possible, to avoid the kind of disgraceful situation at Leas Cross. Second, we must work to introduce a properly resourced and funded inspectorate, not only for nursing homes but also for child care institutions. We are preparing the necessary legislation, which will be in the House in the autumn.
People throughout the country are shocked and justifiably outraged at the revelations regarding the abuse of senior citizens in nursing homes. They hold the State culpable because it has failed to protect senior citizens. Is the Taoiseach aware that many thousands of senior citizens throughout the country do not need residential care but need services within their communities in order that, in their later years, they are not found isolated and alone? There is a need for a network of day care centres and, specifically, for the immediate resourcing of those centres already in place but as yet neither staffed nor resourced.
Is the Taoiseach aware that there are newly built centres, including health centres, with specially designated day care units for senior citizens, for example the centre at Cootehill, County Cavan, in my constituency, lying idle because they have neither the personnel nor the equipment to commence services, including, in the case of Cootehill, the provision of a bus service to access some 200 senior citizens from a wide hinterland? Is the Taoiseach aware that the then Minister for State at the Department of Health and Children, Deputy Callely, gave a commitment that the centre at Cootehill would be up and running for our senior citizens in advance of last year's local and European elections?
What will the Taoiseach do to ensure communities such as Cootehill, County Cavan, and elsewhere have the same level of service and enjoy the same access to day care provision as other communities throughout the country? Will he insist on lifting the staff ceiling currently in place within the health services to accommodate the staffing needs of these facilities? Will he arrange for the provision of the additional financial allocations necessary to see these essential services up and running, and not ask communities and senior citizens, in the twilight years of their lives, to accept the promise that the Government and the services will look more favourably on their needs in the coming year?
Thankfully, day care facilities in most of the former health board areas have very good accommodation. I have visited many health care units throughout the country, new and old, which are well staffed and provide recreational, medical and, in many cases, meal services during the daytime. These services are being extended every year.
The Government is spending €1 billion per year on the care of the elderly, which is a significant amount. There is a capital programme in each region, which includes allocation for the costs associated with such programmes, although I do not have details on individual programmes. Resources are being constantly expanded and extended. Each year we try to improve services and bring more on-stream, in the rural heartlands as well as the cities. We will continue to do so. If the Deputy wishes to provide me with the details of the centre in Cootehill, I will get somebody to look at the matter.
I welcome the fact the Taoiseach has invited a submission on the specific case to which I refer. I take this opportunity not only to appeal in regard to the Cootehill case but all cases, because, while capital provision has been provided, running costs must also be provided. In the case of the centre at Cootehill, which has a staff allocation of 5.8 by HSE assessment, estimated running costs are of the order of €273,000 in a single year in regard to the provision of staff and all other necessary resources.
Is the Taoiseach aware the HSE primary, community and continuing care services section stated that because the Government has ostensibly prioritised the ten-point plan regarding accident and emergency services and the allocation of further investment in the disability services in the current year, it is not in a position to provide for the up and running status of centres such as the Cootehill centre? Does he accept that today, on the first day of the sixth month of the year, it is hard to see how such commitments, important priorities though they are, could have left parked the important resourcing and staffing of these centres?
The commitment of whole communities, which have laboured to put the bricks and mortar in place over many years, to continue to give voluntary service to these centres needs to be met by the Government. It is incumbent on Government to respond positively and immediately. If we continue to put this off, year in and year out — there has been a three year delay in regard to the example I gave — how many of those senior citizens, who have laboured, campaigned, lobbied and raised funds through the years, will never see up and running the fruits of their labour, and will never get the chance to enjoy a day care centre in their community? We need to act now. That is my appeal.
I have no argument with continuing the provision of day care centres. As I stated, we spend €1 billion annually on the care of the elderly. Every year, we have increased resources in this area and opened more care centres and community centres. Many of these are helped by excellent voluntary community workers, who raise funds and give assistance, sometimes by providing land. All of these services are greatly appreciated and help to provide the service.
The capital programme in health has been allocated €600 million for this year. We are constantly providing new and additional services for senior citizens, including longer hours, in complexes and adjacent to health centres. I am sure all of us, as public representatives, attend openings and meetings to lobby for staff and improved services. The situation is improving and I accept this must continue. The Deputy's point is that we should continue to do that, and we will.