Liam Twomey (Wexford, Fine Gael)
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Question 1: To ask the Tánaiste and Minister for Health and Children the efforts she has made to introduce an independent nursing home inspectorate; and if she will make a statement on the matter. [21492/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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On 7 April 2006, in line with commitments I gave during the debate on the Health Act 2004, I published, for consultation purposes, the draft heads and general scheme of a Bill providing for the establishment of the health information and quality authority, HIQA. Included in the scheme is provision for the establishment of the office of the chief inspector of social services within HIQA. The office of the chief inspector will be assigned responsibility for the inspection of residential services for older people, including private nursing homes.

The public consultation on the draft heads concluded last Friday and I intend to seek Government approval as soon as possible to commence drafting the full Bill. It is my intention to publish the Bill during the autumn session.

Liam Twomey (Wexford, Fine Gael)
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This is a difficult point for many on this side of the House because the Tánaiste is doing nothing to protect patients in nursing homes. On this date last year, during Leaders' Questions, the Taoiseach stated: "The legislation will not be ready before the summer but will be introduced in the autumn". That was to be the autumn of 2005, not 2006.

Does legislation prevent elderly patients being tied to chairs or beds? Will it stop staff shouting at patients? Would it have kept alive Peter McKenna and many other elderly patients in similar circumstances? That is a question we and the Tánaiste should ask.

The Tánaiste has a terrible record with regard to legislation. She has a sense that the public does not understand legislation and, therefore, she does not have to care about what it means, which is an important point. The Minister for Justice, Equality and Law Reform has shown the public how important legislation is in the past week. The Tánaiste should give a much clearer answer as to why she has failed to deliver this legislation in the past 12 months.

We are in the House as legislators, which is our official title. However, we have failed to deliver the most basic legislation to protect vulnerable elderly people in nursing homes. It has been discussed and the Government included it in its election manifesto in 2001, otherwise known as the health strategy. It included it in its programme for Government when the Government was re-elected, promising to protect patients. When the Leas Cross scandal broke last year, the Tánaiste and the Taoiseach said all the right things when in front of the television cameras but in the past 12 months they failed miserably to deliver the type of legislation the House is supposed to deliver to protect elderly people.

It is not good enough to tell the House the social services inspectorate will be part of the health information and quality authority, when or if the authority sees the light of day during this Administration. The issue of the health information and quality authority Bill is currently out for public consultation. It may be back by September but it is also possible it will not see the light of day. We are not moving quickly enough in this regard.

In the past 12 months we have come back to the House with emergency legislation on at least two if not three occasions, and we will do so again tomorrow. It is a damning indictment that we are officially described as legislators yet this is the sort of carry-on we must put up with. The two-line response of the Tánaiste to my question is not good enough. I would prefer to know why she and the Department failed to introduce the Bill in the past year. What excuses are they giving each other? They need to fully comprehend the importance of this legislation and what it means. It is just another Bill lying around the Department for God knows how long, just as reports which the Tánaiste is afraid to publish are lying around. Where is the O'Neill report, which we have heard nothing about? We have Question Time to get proper answers.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy misunderstands the situation. I have been in the House for 25 years and was in the Seanad for four years before that. I mention that because there has never been a time when more legislation in the area of health was passed or in the pipeline than in the past couple of years. Legislation in the Department of Health and Children is getting much greater attention and priority because the focus and role of the Department is clearer as a result of the division of responsibilities between the Department and the HSE.

We published the health information and quality authority Bill but it was decided to pursue the social services inspectorate in a different way than had first been suggested. Instead of having fragmentation in the health services, given that we spent the past year bringing things together, we do not want to establish a host of new organisations and then at some future point try to bring them together, with all the associated cost and inefficiency. The decision has been taken to make the social services inspectorate, which will among other things inspect nursing homes, not just in the private sector which is the norm at present but also in the public sector, part of the body that has responsibility for setting standards for health service delivery. That is a sensible suggestion which has been well received.

I decided for good reasons to put the Bill out to public consultation. The consultation process closed last Friday. I am not sure if the Deputy made a submission but, whether he did, a number of submissions were made. I have not yet had an opportunity to study the submissions but I hope to do so soon. I want to take on board the good opinions and advice that will come from the consultation process.

The important point with regard to legislation, which I am sure the Deputy will acknowledge, is to have correct legislation. I will not suggest to the Deputy that legislation by itself will stop awful things happening to old people, whether in their homes or elsewhere. However, we will have legislation that will be enforced, we will have statutory backing for standards, we will have a multidisciplinary team of inspectors and those nursing homes in the public or private sector that do not meet the high standards will not be registered and, therefore, will not be in a position to operate as nursing homes. This is a radical departure from the current situation, where the inspection process is part of the organisation that must deliver services, which is the way it has always been in this country but which is not appropriate. We will have robust legislation. A number of questions will be dealt with later, including one on Leas Cross.

I am not withholding any report. I have not seen Professor O'Neill's report or received it from the HSE, which commissioned it so I am not in a position to publish anything. Reports, whether we like it, must follow a legal process — it is a cumbersome process at times — or an injunction can be made against us to prevent us from publishing them, which would not be satisfactory. I have not seen the O'Neill report nor am I in a position to publish it. As soon as it has cleared the legal issues, it will be published, as it should be. Concealing information is not on my agenda, which is why in recent days we extended freedom of information to a host of health organisations, which will be helpful.

Liam Twomey (Wexford, Fine Gael)
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The Tánaiste must have watched the programme on the disgraceful situation at Leas Cross. The health information and quality authority Bill was proposed as long ago as 2003. At what stage did she decide she would include the social services inspectorate in the Bill? Why are there so many delays? This should have become a priority. It was already well known that the Tánaiste wanted to introduce the Bill before the Leas Cross scandal. It became a priority for the Tánaiste, the Taoiseach and the Minister of State, Deputy Seán Power, this day last year. Only the public consultation aspect has finished. I did not make a submission to the Tánaiste because I consider it more appropriate to make my submission here where everybody is supposed to be held to account. I know the Tánaiste is inclined to take matters out of the House to take away democratic accountability but that is not right. What is the reason for the hold up? Why can we not move quickly and have the legislation by the end of October or November?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I said in my response that I hope to have the legislation in the autumn session but I want to have robust legislation. We have spent some considerable time during the past year working on appropriate standards and looking at best international practice in this area. We want appropriate standards that can be enforced so that when inspectors inspect places where older people and others reside, including children, they will know what to look for and that those units that do not comply with the standards will not be in a position to remain as a registered residential unit for older people.

Seán Ryan (Dublin North, Labour)
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Question 2: To ask the Tánaiste and Minister for Health and Children if she will report on the type of problems being identified in respect of the present unsatisfactory inspectorate system of private nursing homes; and the action which is being taken to address these problems. [21482/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The inspection of private nursing homes is the responsibility of the Health Service Executive under the Health (Nursing Homes) Act 1990. The 1990 Act provides for the registration and procedures for attaching conditions to the registration of private nursing homes and for de-registering homes. The Nursing Homes (Care and Welfare) Regulations 1993 set out the standards to which private nursing homes must adhere to remain as private nursing homes.

In accordance with the regulations, the Health Service Executive carries out inspections of private nursing homes. The HSE has inspection teams in each area. Each team comprises a senior area medical officer, a director or assistant director of public health nursing and a principal or senior environmental health officer.

Each nursing home receives an integrated report following inspection which contains recommendations on best practice, which are required for continued registration. Under the 1990 Health (Nursing Homes) Act and the 1993 regulations, the Health Service Executive can attach particular conditions to registration. Any deviation from these conditions can be subject to sanction. The type of breaches identified during inspection by the HSE include contracts of care with relevance to detail of fees and updating of fees, undertaking regular fire drills and maintenance of fire fighting equipment, hygiene levels, care levels, accident prevention policies, drug record maintenance systems, accuracy of staff rotas and appropriate stimulation-entertainment activities for clients to engage in.

Two inspections per year of every nursing home are required in accordance with article 44 of the regulations. In addition, the inspection teams carry out follow-up inspections as required and also conduct advice visits for prospective nursing homes. The HSE is committed to publishing inspections reports on nursing homes and this will happen from mid-July onwards.

Seán Ryan (Dublin North, Labour)
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That is the theory but, in practice, the position is completely different. Does the Tánaiste accept that older people in need of care, especially those who must leave their homes and go into long-stay institutional care, are among the most vulnerable in society? Does she accept we do not have a fair and equitable system of financing care? Does she accept we do not have clear and transparent rights and entitlements for older people in nursing homes? We do not have a system that ensures quality care is delivered. Does the Tánaiste accept we have allowed care facilities to develop in response to tax laws rather than to the real needs of older people?

Is the Tánaiste aware — this is some of the information sought in the question that I did not get — that as far back as 2004 and earlier, problems in nursing homes, such as staff shortages, nursing policy issues, maintenance and accommodation standards, hygiene, lack of activities for residents and lack of equipment, were known to her Department and officially recognised as such? Does the Tánaiste accept that nothing has been done? Does she accept that the lack of care of older people as well as the neglect of younger people, as witnessed in recent days, is the hallmark of the Government? Rather than speak about the issue, when will the Tánaiste deal with the issue?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I do not accept the Deputy's assertion. In Ireland, the majority of nursing homes in the public and private sector are of the highest possible standards. Those that have and cause problems are a tiny minority but, even if it is only one, that is not good enough. I share the Deputy's view that older frail people are among the most vulnerable in society, many of whom suffer from illnesses of the mind and may not be in a position to understand what is happening and may not have family members or others who can care for their needs. That is the reason they are entitled to look to the State for the highest standard of protection and care. We have laws in place. They are deficient and that is the reason we are changing them. We want to move to a position where the inspectorate is independent of the service provider and where the regulation and inspection is so robust that if nursing homes do not meet the requirements, they will not be in a position to continue to care for patients.

Leas Cross nursing home has been closed. I do not know if somebody else will acquire the property and open it as a residential care centre. One of the lessons everybody must learn if they care for elderly people is that it is not acceptable to society or to the authorities to have a level of care that does not meet the highest possible standards. I do not accept we have left the provision of care to mainly tax-based schemes. In this year's budget, the largest ever package for care of the elderly of €150 million in a full year was provided. That by a huge margin is the largest package ever provided.

My priority and that of the Government is to try to support as many older people as possible to remain in their homes. Some 28% of those in residential care have either a low or medium level of dependency and may not, in different circumstances, have required residential care if there had been home supports. We are seeking to put in place home supports. This year, approximately 3,000 are being supported at home through home care packages in addition to those who have home help and other supports. In the coming years, we may need to move to support approximately 7,000 to 10,000 or, perhaps, 10,000, 12,000 or 15,000 as the population ages. Clearly that will take time. When that support is in place, many more will be able to remain in their homes. Whether it is at home, which is usually the desire of every older person and their family, or in institutional care, we want to ensure that as a society we provide the resources, the services and the statutory framework to enforce high standards in order that older people can expect to live out their lives in dignity, with respect and with high standards of care.

Seán Ryan (Dublin North, Labour)
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What happens to older people who need care but for whom it is not provided in the community and who cannot get a health board place and cannot afford a private nursing home? That is a fundamental question posed by thousands of older people. Can the Tánaiste give me the answer?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We have provided €110 million this year, which is €150 million in a full year, towards additional supports for the elderly, including the provision of specific services in the community, because community services are not just about home care packages but putting in place therapists and others who can support people living in the community. Chiropody is an important service for diabetics. Physiotherapy and so on is also important.

In Ireland there are 20,000 people over 65 years of age in long-term care. That is approximately 4.5% of that age group. That is the international average for people over the age of 65. In different circumstances, perhaps 28% could be at home. The State has contracted beds in certain places where it has not been in a position to provide publicly funded beds. Nobody gets a bed for free. Some 90% of the cost is paid for in the public nursing home and people are expected to pay only 80% of their old age pension. In a private nursing home the position is different. It is inequitable and there are proposals relating to the funding of long-term care before the Cabinet which have been included in the social partnership talks. It is a major issue for society. How will we assess who is entitled to it? We all accept that everyone could not possibly be entitled to fully publicly-funded care in their older years, because that would not be affordable and would not be fair to those who are very well off. I want to see low and medium-income earners getting greater support, and the same support whether the State is in a position to provide a public nursing home bed or whether the individual must try to acquire one in the private sector. There has to be equality of support. I hope those policies will be finalised this month.

Seán Ryan (Dublin North, Labour)
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What the Tánaiste said gives no joy to the thousands of people waiting twelve and a half years on a waiting list for public nursing homes, and who will die before they get public beds.

Mary Harney (Dublin Mid West, Progressive Democrats)
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What people are concerned about is a bed, whether it be publicly funded or privately provided. They want high-quality care in a residential setting regardless of who provides it. That is the challenge for us, to ensure we support that.