Dáil debates

Wednesday, 27 September 2006

Private Members' Business

Nursing Homes: Motion.

7:00 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I move:

That Dáil Éireann,

concerned at:

the failure of the Government to publish Professor O'Neill's report into deaths at Leas Cross nursing home;

the failure of the Government to fulfil promises made in this House by the Taoiseach and the Minister for Health and Children to introduce legislation to provide for an independent statutorily-based inspection regime for all nursing homes; and

the lack of information and transparency about standards applying to nursing homes;

calls on the Government to:

immediately publish Professor O'Neill's report;

bring forward the promised legislation as a matter of urgency; and

make all inspection reports directly available to residents of nursing homes and their families and accessible to the public, free of charge.

I wish to share time with Deputies Crawford, Connaughton and McManus. When the House discusses Private Members' motions concerning the health services, all Members get a sense of déjÀ vu. The same territory is gone over repeatedly, with little or no change or improvement to the health services. The Private Members' motions I have tabled in this House included one on the North Eastern Health Board. Today however, Members discussed the report on the death of P. J. Walsh in the very same area debated in a Private Members' motion nearly two years ago.

More than one year ago, the House debated a Private Members' motion on the need for a social services inspectorate, which again is central to tonight's debate. Moreover, the House has debated another issue central to tonight's debate in a Private Members' motion, namely, accident and emergency departments. Hence, there is a sense of déjÀ vu and of the present Government doing little to improve the health services. This is certainly the case in respect of debates on Private Members' motions.

I wish to outline a brief history as to what has happened regarding care of the elderly in the past five years, as this is the basis of tonight's motion. It started well, with the publication in 2001 of the health strategy, Quality and Fairness — a Health System for You. The strategy included the establishment of a social service inspectorate on a statutory basis, as well as the promise of legislation regarding elderly patients' entitlements. As it was published nearly five years ago, one would expect some progress regarding these issues. However, there has been little.

In July 2003, the former Minister of State at the Department of Health and Children, Deputy Callely, who championed himself as a man who looked after the elderly, made a statement. In the Official Report, 1 July 2003, vol. 570, col. 474, he stated: "[At] present health boards are involved in the preparation of draft standards of care for residential institutions for older people". However, like the former Minister of State himself, this appears to have gone by the wayside.

Although the process of revolutionising the health services was begun enthusiastically by the Government, the first storm clouds began to gather in or around 2003. This was also when the Mercer and O'Shea reports regarding the future funding of care for the elderly were published. The then Minister again promised immediate action. Unfortunately, by 2004, the former Minister for Health and Children in question, Deputy Martin, had his own problems to deal with because of the Travers report's publication. The latter both demonstrated the ineptitude of Ministers in respect of the health services and of care of the elderly in particular, and showed how little was being done by the Government.

Hence, while matters regarding the health service began well in 2001, by 2004 things were going downhill rapidly and one can see why. In 2005, another watershed took place when the "Prime Time Investigates" documentary exposed what was happening in nursing homes. Major contributions from all senior Ministers involved are extant and it will do no harm to put them back on the record.

The Taoiseach, in the Official Report, 31 May 2005, vol. 603, col. 495, stated: "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". During a debate on a Fine Gael Private Members' motion calling for the establishment of an independent inspectorate for all nursing homes, the Minister of State at the Department of Health and Children, Deputy Seán Power, who is present, stated: "The social services inspectorate will be established on a statutory basis" — Official Report, 31 May 2005, vol. 603, col. 554.

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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We are almost there.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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The Minister of State is always almost there.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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People have died because of the Minister of State's inaction.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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That is what happens.

Photo of Rory O'HanlonRory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Deputy Twomey, without interruption.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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In June 2005, the first report on Leas Cross, namely, the Hynes report was published. It also exposed many matters which are still under discussion tonight. What has been done since its publication? Nothing appears to stir either the Minister of State or his colleagues into action in respect of care of the elderly. The Minister for Health and Children, who prides herself on being a can-do Minister, stated:

on the social services inspectorate, we will have the legislation ready later this year. The Minister for State, Deputy Power, is working on it. I am optimistic that we will have an appropriate inspectorate for our nursing homes.

While she may have been optimistic, this was stated in July 2005. Again, I have not seen anything happen. In addition, the Cabinet established the interdepartmental working group on future funding of care of the elderly at this time. However, as the House discovered earlier today, little has happened in this respect either.

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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That is a complete misrepresentation.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I am simply reading from the Official Report. I will move on to 2006, by which time the Government had promised that everything would be different. However, 2006 did not start well due to the publication of the Our Lady of Lourdes Hospital report and the recommendations by Judge Harding Clark to make improvements in the health service a priority. Little has been done in respect of that report. At the time, the Minister for Health and Children noted that doing nothing was not an option. Obviously, as far as care of the elderly is concerned, this is quickly fading from the Government's memory. In the Official Report, 1 February 2006, vol. 613, col. 1705, the Minister for Health and Children stated:

The legislation providing for the establishment of the social services inspectorate on a statutory basis is being incorporated into the Bill establishing the health information and quality authority, HIQA. The preparation of the heads of this Bill is at an advanced stage in my Department and I expect to be in a position to submit them to Government within the next month.

At the time, the Minister also spoke of how important the social services inspectorate would be and that she would establish a working group. She referred to another working group with membership drawn from "[her own] Department, the HSE, the social services inspectorate and the Irish Health Service Accreditation Board". This working group was established in February 2006. Interestingly however, while the same Irish Health Service Accreditation Board produced its own recommendations on standards in nursing homes the previous November, nearly a year later Members still await their publication by the Department. Hence, setting up working groups about which one does nothing is a pure waste of time.

Matters have become so bad that the owners of private nursing homes have published their own standards. The Excellence Ireland Quality Association published its own standards as to what should be expected in nursing homes. The difficulty for such owners is that the standards are non-statutory and non-binding. Hence, anyone who so wishes may continue following the practices operated at Leas Cross. Deputy O'Dowd will outline how weak those standards are in those nursing homes which exploit elderly people.

In the Official Report, 1 June 2006, vol. 620, col. 1845, the Minister for Health and Children stated: "Last year, beds were offered that were not procured because of the results of previous inspections." Hence, although the health boards themselves do not act on these inspections, she continued by stating: "I accept that we need to strengthen the law in this area". Again, this gives the impression that somehow, realisation has dawned on the Minister for Health and Children that she must do something about this major issue. Even the Taoiseach, in the Official Report, 14 June 2006, vol. 621, col. 1058, stated: "I have announced many times that the legislation in question is being prepared" and we "hope to pass this legislation later this year after it has benefited from the wisdom of the consultation process". — Official Report, 14 June 2006, vol. 621, col. 1059. Unfortunately, although the consultation process is long over, there is still no sign of this legislation.

Moreover, the O'Neill report, the second major report on the same institution, has now been completed. The Government again refuses to publish it. However, what is known about this report is interesting. It states: "what occurred at Leas Cross cannot be assumed to be an isolated incident". One of the main recommendations in the report is that the Department of Health and Children should establish a clear policy regarding care of the elderly and that a national monitoring system for vulnerable patients be established. This is something for which all Members have called and which has been part of the Government's strategy since as long ago as October 2001.

I will provide the Minister of State with a brief overview as to what is happening as far as the Department of Health and Children is concerned. In the past five years, health policy for care of the elderly has gone from being an enthusiastic hope for the future to dying a slow death. The difficulties with the O'Shea and Travers reports and the lack of legislation for the protection of elderly patients became clear in the mid-term of the Government. However, what transpired during 2005 and 2006 shows what happens when a Minister talks the talk but does not walk the walk. This applies to the former Minister for Health and Children, Deputy Martin, and the current Minister, Deputy Harney, because neither of them delivered much on solving the crisis in accident and emergency departments or in respect of the Hynes report, the hospital hygiene audit report, the report on Our Lady of Lourdes Hospital or the report into the death of Mr. P.J. Walsh. Now we have the O'Neill report.

During a discussion with the Minister of State this morning at a meeting of the Select Committee on Health and Children on legislation to change the subvention payments, numerous weaknesses were exposed in the legislation. The one on which I believe most people will comment is the removal by the Government of an appeal system established under ministerial regulation, which is not included in the legislation that the Minister of State expects Members of this House to vote in favour of in the next few weeks, and in that regard people are expected to wait for guidelines to be issued by the Health Service Executive. The position has changed from patient care being covered by regulation to now being covered by guidelines, and the Minister of State is saying this is a matter on which we must trust the HSE. I note from the Dáil schedule that the Health Information and Quality Authority legislation, to which the Minister of State referred, will not be ready until 2007, which is a little along the lines of the song "What's Another Year".

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank my colleague for sharing his time with me on this important issue. The Leas Cross scandal and similar issues cannot be swept under the carpet. It is vital that the report into that scandal should be made available. Were it not for people such as Deputy O'Dowd and Deputy Twomey and our party leader, Deputy Kenny, this issue might never have come to the surface and information on the terrible conditions in that home might not have been revealed. I congratulate those in the media who were prepared to expose this issue.

The main issue with which I want to deal is how provision will be made for the needs of the elderly in the future. I am very fortunate, as is the Ceann Comhairle, that in County Monaghan we have facilities such as St. Mary's Hospital, which is owned by the Health Service Executive and, fortunately, it is not under the same management as some other institutions in County Monaghan. St. Mary's Hospital is excellently run, as is the Sacred Heart Home for the Elderly in Clones, the nursing home in Ballybay and most of the other private nursing homes in the area.

Elderly people and people with disabilities are important members of society and we cannot allow them to be treated other than in a proper manner. A proper nursing home inspection system must be put in place. At a meeting yesterday we discussed EU inspections of products imported into this country and were told that the next inspection would take place on a date next January in order that everybody would know when an inspection of Brazilian beef would take place. The only way in which nursing homes can be properly inspected is for inspectors to be able to visit them at any time, day or night, to ensure a proper service is being provided for the patients. Nothing less will suffice.

It is vital that such an inspection service is put in place to ensure that the necessary service is available to patients at all times in all nursing homes. Whether patients are in public nursing homes or in private nursing homes, as are the majority, it is vital, given the amount of money being spent and allocated to these institutions, that the best service possible is available. Care must be taken to ensure that fire safety measures, including fire drill, are up to standard, as is required in other private businesses. We must also ensure that pest control measures, a refuse service and all such services are adequate.

I wish to deal with the issue of the facility to make complaints. I was contacted by a family member recently who advised me that if the family made the slightest complaint to the nursing home in question, they found they were no longer on speaking terms with the staff and the family were asked not to cause any further annoyance. This family were paying for their loved one to be cared for in that nursing home. There must be a clear line of communication and assistance between those in charge of administrating subvention payments and such matters and the patients and their family members. If a personality clash arises between a patient and nursing home staff, the patient should have an option to move to another nursing home.

In the case I dealt with, the nursing home concerned was glad when a difficult position was dealt with and the person concerned is now happy being cared for in another nursing home. Such personality clashes can arise. A proper structure must be in place in nursing homes whereby people can feel free to make a realistic complaint and be confident it will be dealt with.

The administration of drugs and medicines must be clearly defined. Most nursing homes deal with this matter very well but it must be properly organised. Patients must have the right to refuse treatment or, in consultation with relatives acting on their behalf, to seek the best advice on proposed treatment.

Nursing home staff should also discuss with residents their dietary needs, including the variety and types of food they require, as food is an important consideration. I know of a person who went into a nursing home four and half a years ago and people thought she would not be still there in a few weeks' time or at most a few months' time, but with good care she is still there and living a reasonably active life. It is important for such residents to have the variety of food they require and their dietary needs are cared for in a reasonable way.

I wish to deal with nursing home subventions. There are various problems in this area in the north-east region, one being the lack of funds. In the early 1990s, a number of patients in the area were provided for across the Border, as that opportunity was presented, and as a result we seem to have a low quota.

A case involving a 90 plus year old patient who applied for subvention payment was brought to my attention recently. This lady lives in an ordinary cottage which she does not own. She was refused subvention because she said she did not have any money or accounts and those administrating the scheme did not believe her and sent her back her file. This lady lives on her own. She has had to pay taxi fares to go to her doctor and has incurred other expenses. It is not difficult to understand how she has no money. Fortunately, for the time being she has been able to go back home and is being looked after by her loved ones.

This type of attitude towards the elderly must be seriously examined and investigated. Sadly, this lady had no one to do a whip-round, she will have to stay at home until such time as some of us can negotiate on her behalf with the staff in the office administrating the scheme and argue that she has a valid case in that she does not have much resources and needs support.

The Government has been in office for nine and a half years and it is time such issues were dealt with. There is also the issue of the home help service. The Ceann Comhairle is aware of a case in his home town where a person has the services of a home help for two hours compared with having received the services of a home help for 12 hours when living in Donegal. There must be some degree of responsibility and realisation that people who need this service cannot live on fresh air. They need proper and substantial help if they are to be able to live at home and not in nursing homes.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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I wish to share time with Deputy McManus.

Photo of Rory O'HanlonRory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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That is agreed.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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I have taken part in a number of discussions on nursing homes in recent years. The catalogue of failure is nothing other than a disgrace. We all have to accept that the RTE investigation into Leas Cross represented a milestone in the evolution of nursing home care. Never in the history of care of the elderly was anything more starkly brought across to the public about what could happen. I am from a county where I hope and have every reason to believe that most nursing homes, at least the ones I know about, are run very well. However, that is not enough. When I heard about the non-publication of Professor O'Neill's report I was shocked. I have no idea what is in the report but I have never heard a case of such a document not being published where everybody concerned had the interest of the elderly at heart.

I assume several interests are involved, though I am not privy to them, and that there are people in very high places, whether connected to the HSE or to ancillary services, whose noses would be put out of joint if the report was published. Does the Minister of State, or his senior Minister, know what is contained in it? It will shame everybody if it cannot be published.

If the will existed to publish the report it would have been published under the privilege of this House, as has been done many times before, such as with public accounts and many other reports. Why was that not done with the O'Neill report? Why was it not brought into the House and made public?

Photo of Seán PowerSeán Power (Kildare South, Fianna Fail)
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If it was that simple it would have been done.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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I do not accept that. This case concerns the person lying on his or her back in a nursing home anywhere in Ireland. Nothing else counts. It all depends on the quality of care for that person. Nothing else matters if the appropriate care is not given to a person who lies on his or her back for 24 hours a day, seven days a week, every day of his or her life. They are the people whom we are here to protect. Over the years we decried what happened in industrial schools. It was a dark age but we said people did not understand. The statutory authorities responsible for inspections did not carry them out. In this modern age we are in the same position again. I have said many times that for inspections of nursing homes we need a flying squad mentality. Inspectors should be able to strike at any time, day or night, any week of the year. If there is nothing wrong nobody should object.

Can the Minister of State imagine the suspicion that has been aroused by the failure to bring the O'Neill report before the House? I have no idea what is wrong with it but a great number of elderly people are beginning to wonder what it was that Professor O'Neill said about Leas Cross that prevented it being brought onto the floor of this House and made public.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Hear, hear.

Photo of Paul Connaughton  SnrPaul Connaughton Snr (Galway East, Fine Gael)
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If the Minister of State or I were in the same bed as they and had a personal interest in the matter we would say exactly the same thing. The sooner he brings the report before the House the better, irrespective of whom it hurts. Personnel issues must be involved and vested interests must have expressed disagreement with Professor O'Neill. If that were not the case then it would be published. I believe the Minister of State has the best interests of the elderly at heart. Why would he not? There would be no marks for that as that is why we are here. The suspicion has now been created that the O'Neill report cannot or will not be made public because of a cover-up.

I expect that after tonight's debate the report will be put on the floor of the House for us to see its contents. We are all adults and will all find out what the learned professor had to say. He would not have been given the job unless somebody in the Department thought him the right person for the job. There is no point commissioning a professional report and deciding, for a reason best known to the Government, it cannot be published. That is what happened at Leas Cross at the very beginning.

I sincerely hope the report is made public, irrespective of whom it hurts, because then we will know who genuinely has at heart the welfare of people who are not able to speak for themselves. We are very lucky to have fine carers but if one person out of 15,000 is abused, for any reason, or denied their rights it is one person too many.

I will return to where I started. Until I see the day when a flying squad of appropriately trained men and women can walk into any nursing home, private or public, at any hour of the day or night I will know the Government does not take the situation seriously.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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I welcome this debate and thank Fine Gael for the opportunity to speak in it. I start by reminding the House of the statement the Minister for Health and Children made recently: "It would not be acceptable to me or the Government if this report were to remain unpublished." However, the Minister for Health and Children has the power to guarantee publication and it is time for her to use it. It is quite simple. Instead of doing so, the Minister has called on the HSE and Professor O'Neill, the author of the Leas Cross report, to work together to create the conditions necessary to facilitate publication. As far as Professor O'Neill is concerned, and according to his interpretation of the terms of reference, the report is finished and ready for publication. It is time for the Minister to live up to her own rhetoric. She has the legal authority to break the logjam and I urge her to use it.

The Minister has power to issue directions to the HSE under section 10 of the Health Act 2004. The directions may be either general or specific. Under section 10(1), the Minister may issue general written directions to the executive "for any purpose relating to this Act or any other enactment, and concerning any matter or thing referred to in this Act as specified or to be specified, or as determined or to be determined, by the Minister".

Under section 10(2), the Minister may issue specific written directions to the Executive "concerning the submission to the Minister, in such manner and within such period as the Minister may specify, of reports on any matter relating to Part 7 (Accountability) or relating in any other way to the performance of the Executive's functions, even though such reports are the subject of a direction under subsection (1), and any information or statistics relating to the performance of the Executive's functions".

Subsection (5) provides that the executive must comply with a direction issued by the Minister under this Act.

It therefore appears open to the Minister to direct the HSE to provide her with copies of the O'Neill report. It also appears open to the Minister, once the report is formally in her possession, to refer it to the Joint Committee on Health and Children. The committee could then publish it, a precedent which has been followed on previous occasions. I was involved in such a process relating to the scandal surrounding sexual abuse in swimming. It is within her power to do so and it is time for her to match her words with action. The result of the ongoing failure to publish this report is the belief among many members of the public that these types of reports are commissioned but nothing ever happens. There is no personal accountability and the track record of Ministers for Health and Children on this is not good. The public deserves answers to the questions raised on standards of care for the elderly. The process of reforming the way vulnerable sections of our society are treated is stuck in a bureaucratic and legal quagmire and the valid fear is that it will be left there.

Some 16 months have passed since the screening of the "Prime Time Investigates" investigation into Leas Cross nursing home. This was not the first time the Government's attention had been drawn to concerns that the elderly, in particular those in long-stay care, may be particularly vulnerable to human rights abuses. The Human Rights Commission's report entitled Older People in Long Stay Care was published in November 2002. Its concerns over the inspection of private nursing homes were clearly stated as follows:

Inspections are rarely, if ever, carried out at night; the inspection is largely concerned with the physical conditions and rarely addresses what might be termed broad quality of life or social gain issues; the Health Boards take very few prosecutions and almost never close down a nursing home. The sort of breaches of the law which were regularly mentioned in the reports included the absence of contract of care, inadequate records of medication and the use of restraint, insufficient arrangements for privacy and the absence of safety equipment.

This report, which is almost four years old, elicited a response from the Department of Health and Children only seven months after its publication and even then the Department did not engage with the issues raised. A similar indifference by the Department of Health and Children and the HSE is now being experienced with the Leas Cross report.

In May 2005 "Prime Time Investigates" aired its investigation into Leas Cross which exposed degrading and humiliating treatment of its elderly patients. These elderly people are some of the most vulnerable people in the State. The treatment of these elderly patients in the care of this nursing home appalled viewers. It became a matter of national scandal and was discussed here in this Chamber. The images depicted so graphically on "Prime Time Investigates" were shameful for our society and it was shameful that this could happen in modern Ireland.

This is not just a case of elderly patients being stripped of their dignity but a system that is putting the health and even the lives of vulnerable, elderly patients at risk. What we witnessed was a Government that failed in its duty of care to its most vulnerable elderly citizens. The Government responded by making three promises: an independent nursing homes inspectorate, a team of elder abuse case workers and a report into the 95 deaths in Leas Cross. The Government has failed on all three promises. It has failed to publish legislation to establish an independent nursing homes inspectorate. In the days following the "Prime Time Investigates" exposure the Taoiseach spoke in this House. He makes many statements in this House and appears to subsequently change his tune. On this occasion, 1 June 2005, he stated:

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.

The Department of Health and Children now tells us it will be 2007 before this legislation appears. Appointments to the nationwide team to prevent elder abuse are critically behind schedule. Only five of the proposed 32 elder abuse case workers have been appointed. Although the report on the 95 deaths in Leas Cross has been ready since May this year it has not been published and it is time it was. The author of the report, Professor Des O'Neill, has described the findings as "grave, disturbing, requiring urgent attention". Professor O'Neill believes that the HSE's recent insistence on a "judicial form of tribunal" is outside the terms of reference as given to him. As far as he is concerned, this report is finished and should be published. Professor O'Neill stated:

As it turned out, the review that I conducted gave me cause for grave concern not only as to the standards within that particular nursing home but also, as the specific terms of reference required me to consider, the wider issues as to the setting of appropriate standards and their systematic monitoring and enforcement. As I have previously stated these concerns were grave, disturbing and system-wide, and required urgent attention.

Urgent attention is the one reaction we have not seen. The HSE's response is that this report is unpublishable, yet it must be published. It is up to the Minister to use her statutory powers to guarantee its publication. In the words of Mr. Dan Moore, relative of former Leas Cross resident Mr. Peter McKenna, this report must not serve as wallpaper to cover up the terrible neglect of these elderly patients. As Mr. Moore stated on the death of his relative: "To my knowledge not one person suffered embarrassment, was fined, imprisoned, suffered loss of job, loss of status — nothing".

The revelations of the "Prime Time Investigates" investigation resulted in elder abuse becoming top of the national agenda for a short time. It is time to make it top of the national agenda once more and to seek to fully protect our most vulnerable citizens. We cannot do it without having in the public arena the vital information in Professor O'Neill's report. It is extraordinary that taxpayers are paying for this report which is of grave public concern and which they are entitled to see. It investigates issues that affect our elderly across the board, not just in one nursing home. Even without the report's publication the one fact we know is that the phenomenon is system-wide, and that is why it is so important that the Minister deal with it. There are clearly wider failures in how our system cares for elderly citizens. That does not imply that we do not have good nursing homes. I know many people who are happy and well cared for in private nursing homes across the country. It does a disservice to those who provide that level of care to leave them in a limbo in which they all suffer from a stigma because the information that should be published is not being made available and action is not taken.

The best guarantee we have of ensuring the health service works is full transparency and accountability, which we do not have in our health service. With the introduction of the HSE the existing levels of accountability were stripped away. We have a serious problem with making the service accountable. Whether in the care of the elderly or medical procedures carried out in Our Lady of Lourdes Hospital in Drogheda, without robust systems in place to ensure accountability, terrible things can be done. Terrible things were done and thanks to media exposure we were all able to see what was happening. While we do not know the full extent, the eminent Professor O'Neill has produced a report that will guide us through to the next stage where we can have the kind of protections and safeguards we all want to have when we are old. Hopefully we will all age and be in the position of vulnerability. Without this report we will not be able to make the progress we need. The Minister has the power to make this report public. We gave her those powers when we enacted the Health Act 2004 and I challenge her to indicate to us why she refuses to use them.

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Dublin West, Fianna Fail)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"welcomes the largest ever expansion made by the Government in funding of services for older people by the provision of €110 million additional revenue funding in the Budget announcement for 2006 (€150 million full year cost);

supports the Government's commitment to introducing legislation in the near future which, inter alia, will establish the Social Services Inspectorate function on a statutory basis;

welcomes its commitment to extend the work of the Social Services Inspectorate to public and private nursing homes and to resource it accordingly;

notes the Government's commitment to ensuring that high quality care is made available to all patients in public, private and voluntary nursing homes, and in that context welcomes the preparation of standards for residential care settings for older people;

welcomes the HSE's provision of information to the general public on nursing homes and its policy decision to make nursing home inspection reports available on its website;

welcomes the HSE's provision of information to the general public on nursing homes and its policy decision that all completed inspections of nursing homes be made available to members of the public on request subject to Freedom of Information and Data Protection legislation;

welcomes the proposed implementation by the HSE of a common national approach to the inspection of nursing homes; and

commends its policy of supporting older people in their homes and communities in keeping with their stated wishes, and providing support to those who need residential care, and in that context, acknowledges the legal difficulties in the HSE publishing the Leas Cross Report".

I wish to share time with the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

I welcome this opportunity to address the House on these important issues. The Government has made a significant investment in the care of older persons and palliative care with the provision of €110 million in additional revenue funding in the budget announcement for 2006. The full year cost of that allocation is €150 million.

The Government is committed to maintaining older people in dignity and independence in their own homes, and in accordance with their wishes, for as long as possible and to provide a high quality of long-term residential care for older people when living at home is no longer possible.

It is internationally recognised that about 5% of the older population will eventually require long-term care. People are generally living longer these days, however, and even though most are leading healthy independent lives, the number of people in need of long-term care is increasing. There is a demand on long-stay places. It is imperative that the private nursing home places on offer are of a high enough and appropriate standard.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. These regulations apply only to the private nursing home sector and do not cover public long-stay facilities for older people.

There was a commitment in the health strategy, Quality and Fairness — A Health System for You, to extend the remit of the social services inspectorate to other social services, including residential services for older people. Legislation is therefore being prepared in the Department to provide for the establishment of the Health Information and Quality Authority and the establishment of the social services inspectorate function, as part of the authority, on a statutory basis.

Public consultation on the draft heads and general scheme of a Bill providing for the establishment of the Health Information and Quality Authority has been carried out. Included in the scheme is provision for the establishment of the office of the chief inspector of social services within the authority. The office of the chief inspector will be assigned responsibility for the inspection of residential services for older people, including public nursing homes. The Minister intends to seek Government approval as soon as possible to commence drafting the full Bill. The Minister intends to publish the Bill during the autumn session.

The Health Service Executive national care group manager for older persons services established a national nursing homes steering committee in July 2005. One of the priority tasks outlined for this committee was the standardisation of inspection documentation to make the information on inspections more transparent and more easily understood by nursing home proprietors and the general public. At the time, there were several different reporting templates in use across the country. The HSE nursing home inspection and registration teams use a standardised reporting template on an interim basis. The inspection report is based on the standards and criteria laid down in the Health (Nursing Homes) Act 1990 and the Nursing Homes (Care and Welfare) Regulations 1993. The HSE has commenced publishing these reports on its website.

The decision to publish nursing home inspection reports followed considerable consultation within the HSE and with representatives of nursing homes organisations. The nursing homes organisations have broadly welcomed this initiative. Nursing homes are required to be registered by the HSE. Registration certificates must be placed in a prominent position in nursing homes. If a registration has certain conditions attached to it, these will be displayed on the registration certificate.

When it is necessary for older people to move into long-term residential care, it is important that these older people have a choice of top quality nursing home care. For this reason, the Department has established a working group to develop the standards for residential care settings for older people. Membership of the group comprises officials from the Department, the HSE, the social services inspectorate and the Irish Health Service Accreditation Board. The group has commenced and developed draft standards for the inspection of public and private residential care for older people. It is intended that these draft standards will be the subject of a public consultation process in the coming months.

In addition, the Irish Health Service Accreditation Board has examined the development of accreditation standards for public and private residential care for older people. The Government's commitment to the development of a comprehensive range of services for older people and palliative care can be demonstrated clearly by outlining the considerable increase in resources made available in recent years for service developments. This has resulted in a major improvement in home and community-based support for older people. A comprehensive health and social care service is being developed, in a way that is reliable and that respects and values older people.

This is the largest ever increase in funding for services for older people. These initiatives set out the Government's continued commitment to older people and putting older people at the centre of health policy now and in the future. The investment package is focused on caring for people at home, in accordance with their expressed wishes. It is a major step in focusing new resources on home care first and foremost, while still supporting appropriate residential care. This is in line with international trends and reflects the growing independence of older people who want to stay living in their communities.

It is right that we should devote substantial additional resources to services for older people. They have made a great contribution to our society and to our current economic and social success. In this way, we are saying that the next generations value their contribution and will respect their needs and their continuing role in our society.

This new investment involves additional resources of €150 million in a full year with €110 million in 2006 and €40 million more the following year. Reflecting the new emphasis on home and day care, almost three quarters of the full year costs are being committed to community care supports. This investment is a response by the Government to older peoples' preference for being cared for at home rather than going into residential care. That may often require some additional home help or more developed home support, including various therapy services. All the evidence shows that families caring for elderly relatives continue to provide care in partnership with the support services put in place for those that require it. It is estimated that 28% of nursing home residents have a low to moderate dependency level and many of these residents might well have continued to live at home if the right supports had been made available to them at the appropriate time.

The budget day package provided for a number of initiatives including home care support packages which deliver a wide range of services and have been piloted successfully in several regions in recent years. They include the services of nurses, home care attendants, home helps and various therapists including physiotherapists and occupational therapists. A home care package will vary according to the care needs of the person so that, for example, there might be a greater emphasis in some packages on home care assistants while other packages may require a greater level of therapy and nursing.

The priority is older people living in the community or who are inpatients in an acute hospital and who without this support would need to be admitted to long-term care. The home care packages are also available to older people who have been admitted to long-term care and wish to return to the community. In addition, the packages will be offered to people who are already using existing core services, such as home help, but need more assistance to continue to live in their community.

The packages are delivered through the HSE, by a range of providers including the executive, voluntary groups and the private sector. The scheme is intended to be as flexible as possible and highly responsive to the real needs of the individual so that where a family or friends of an older person wish to provide these services, they will be encouraged to do so, with support, and linking in with the HSE, voluntary or private sectors.

Approximately 1,100 home care packages were provided to people at the end of 2005. By the end of this year a total of 2,000 additional home care packages will have been provided. The 2,000 packages will support more than 2,000 persons as, for example, individuals could in some cases need a temporary care package. The major thrust of this initiative is to be directed at older people.

Home helps are an essential part of supporting older people at home and thereby delaying or preventing admission to long-stay residential care. They also help to keep people out of acute hospitals or help their early discharge from hospitals. There is a continuing demand for home helps because of the increased number of older people. An additional €33 million full year cost has now been allocated for this programme, €30 million of which is for 2006. This represents a significant increase over the Estimates provision of €112 million for 2005 and is used to provide 1.75 million more home help hours.

Day care and respite care centres are an integral part of delivering a comprehensive community service for older people. The service provided may include a mid-day meal, bath, physiotherapy, occupational therapy, chiropody, laundry, hairdressing, social contact among older people, respite for family members and carers and social stimulation in a safe environment for older people with mild forms of dementia.

The provision of €9 million in a full year allows for an additional 1,325 places per week in such centres. The number of older people who will benefit from these new places will be substantially more than 1,325 since, over the whole year, one place can provide a service for more than one person. The investment of €9 million allows for additional programmes for specific needs such as activity therapy. It will also mean that many day care centres can open for five or seven days a week, rather than two or three days as was often the case. There is an investment of €7 million in 2006 with the balance of €2 million being provided the following year.

There is a significant increase in the resources available to the meals on wheels service. An additional €2.5 million has been provided in 2006 together with a further €2.5 million in 2007. This is part of the range of services which help support older people to continue living in their own homes.

The Government strongly supports the development of sheltered housing accommodation for older people, as it provides a real alternative to residential care and reflects the desire of older people to live with as much independence as possible. Some €1 million will be allocated in support of the development of sheltered housing, split evenly between 2006 and 2007, to provide frontline health service support for sheltered housing, such as therapists and public health nurses.

I would like to speak about the development of the nursing home subvention scheme and the provision of additional long-stay bed capacity. Some €20 million is being allocated under the scheme for residents of private nursing homes. This represents an increase of 14% on 2005, when there was an estimated spend of €140 million. The €20 million to which I referred will be used to support the increasing numbers of people who are entitled to basic nursing home subvention, to reduce the waiting lists for enhanced subventions and to bring greater consistency to the different levels of enhanced subvention support throughout the country. Some €8 million is being provided to cover the cost of 250 additional nursing home beds which the HSE has sourced from private nursing homes. Some €9 million was provided in this year's budget for specialist palliative care, including home care and community initiatives. This allocation includes funding for 24 additional extended care beds in Our Lady's Hospice in Harold's Cross. A further €4 million is being allocated in 2007 to develop palliative care services, which amounts to a full-year cost of €13 million.

It is clear from the budget day package that the Government is firmly committed to developing services for older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community-based supports are assisting older people to remain in their homes and communities for longer, in accordance with their wishes. As I have said, additional funding has been provided under the nursing home subvention scheme to support the increasing numbers of people who are entitled to subvention and to reduce waiting lists for enhanced subvention. The issue of the staffing resources needed by the statutory inspectorate is being explored by the stakeholders in the overall context of ensuring that standards are met and health service staff are utilised in the most effective way.

The motion before the House deals with Professor O'Neill's report into the deaths at Leas Cross nursing home and refers to the question of an independent inspection regime. It highlights a lack of information and transparency in respect of the standards which apply to nursing homes. I spoke earlier about the Government's commitment to introduce legislation establishing a social services inspectorate that will inspect all residential centres for older people, including public centres. The failure to publish Professor O'Neill's report cannot be attributed to the Government as it is not a function of the Government to publish such a report.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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That is not true.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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The Government is responsible for it.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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It has statutory authority to publish the report.

8:00 pm

Tim O'Malley (Limerick East, Progressive Democrats)
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I welcome the opportunity to address the House on this important issue, which affects some of the most vulnerable people in our society. As the Minister of State, Deputy Brian Lenihan, mentioned earlier, the Department of Health and Children has a policy of maintaining older people in dignity and independence in their own homes, in accordance with their wishes, for as long as possible. Most older people are fit and well and lead full and independent lives. The Department is committed to providing a high quality of long-term residential care when that is no longer the case. That is the minimum we can do for older citizens, who have played a major part in helping Ireland to achieve the success it enjoys today.

Most long-term residential care is of a high standard and affords a good quality of life to older people who benefit from it. With the best will in the world, however, there will always be exceptions to the rule. As there will always be circumstances in which older people feel vulnerable or exploited, the Department is committed to developing quality standards and putting in place a robust inspection process for public and private nursing homes. The Minister of State, Deputy Brian Lenihan, has outlined the steps being taken in this regard, including the establishment of the Health Information and Quality Authority as well as the establishment of the social services inspectorate function on a statutory basis. The office of the chief inspector will have the function of registering and carrying out inspections, including inspections of services for older people. The Department has established a working group to set out the standards for residential care settings for older people. The HSE will continue to register and inspect private nursing homes under the Nursing Homes (Care and Welfare) Regulations 1993.

The Department of Health and Children is fully committed to developing the services needed to tackle elder abuse. Great strides have been made in recent years in developing supports for older people who feel defenceless. The report of the working group on elder abuse, Protecting Our Future, was launched on 11 November 2002. As elder abuse is a complex issue, it can be difficult to define it precisely. It may involve financial, physical or sexual abuse, or it may arise due to inadequacy of care. It is defined in the report as "a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights". It is hoped that the report, by defining elder abuse, has given older people who feel they are the subject of abuse in any shape or form the confidence to report their anxieties, as appropriate, to a social worker, a public health nurse, a member of the Garda or any professional or care worker. The Health Service Executive recently established a helpline service, which can be accessed by dialling 1850 241850, dedicated to dealing with allegations of elder abuse. It should encourage those who feel they are being abused in any way, or those who witness such abuse, to make the necessary contact and have their voices heard.

The importance the Government attaches to the issue of elder abuse is reflected by its allocation of €2 million in this year's budget to address it, split evenly between 2006 and 2007. Some €2.5 million has been made available in recent years to implement the recommendations of the report. The funding allocated over the next two years will facilitate the implementation of the full range of recommendations. It will help to put in place dedicated elder abuse officers and clerical support workers in each local health office area. It will also provide for the development of a research function in this area.

The report recommends that a senior case worker be appointed to each former community care area. It is anticipated that the HSE will recruit 27 senior case workers soon. One of the responsibilities of the senior case workers, in conjunction with appropriate health service providers, will be to assess suspected cases of elder abuse referred to local health offices. One of the recommendations in the elder abuse report was the establishment of a national implementation group. The group was established in December 2003. In 2005, the Department appointed a senior policy adviser and a secretary to assist the implementation group in its work. The HSE recently appointed a senior officer to assist the group with implementation issues.

The HSE has made good progress on the issue of elder abuse. It has implemented a number of the report's recommendations, including the establishment of steering groups in each former health board area to provide a common response to elder abuse throughout the State. The steering groups comprise representatives of the public sector, private organisations and voluntary organisations, including groups for older people. The groups are developing clear policies and guidelines for the protection of vulnerable adults, on foot of wide consultation with staff. They are progressing their work through the subgroups on legal aspects, policy and procedures and training.

The Health Service Executive has pointed out that awareness training for HSE staff has been provided in line with the report. It has been involved in awareness training with volunteer staff, including staff from the national senior citizens helpline. The issue of elder abuse is being incorporated into professional training courses including gerontology courses. A number of research projects have been undertaken, including the examination and review of medication for older persons in continuing care settings. In addition to these developments, a senior helpline was established with the support of the health boards in 1998. Since 1999, it has received thousands of calls from lonely older people nationwide. The service is confidential and non-directive and is available throughout the State for the price of a local call. The volunteers working on the helpline are all older people who have gone through a rigorous training provided in conjunction with the health authorities.

The helpline handles all manner of issues and is not geared specifically towards complaints about elder abuse, such as the helpline recently set up by the Health Service Executive. However, 5% of calls in 2004 related to elder abuse. These callers established a relationship of trust over a period with the older volunteers taking their calls. Many callers were often unable to seek external or professional intervention until they felt secure in discussing their situation.

The House will agree the Department of Health and Children has taken strides in tackling the issue of elder abuse. It has worked for the past several years, in conjunction with the HSE, to ensure awareness of the issue, both among the public and staff who come into contact with older people during the course of their work. The HSE has made good headway in putting in place structures at local and national level to deal with allegations of elder abuse. It continues to provide appropriate training to staff in this regard. The national implementation group continues to oversee the implementation of the recommendations of the report on elder abuse. The Department has allocated the highest level of funding for elder abuse for the next two years to ensure these recommendations become reality.

Developments in this area must be considered in the wider context of standards of care. The Department is committed to developing person-centred standards that reflect best practice and will ensure older people in residential care receive a level of quality care that is centred around their needs. The Department is putting in place the legislative structures to ensure these standards are complied with consistently in all residential settings for older people. Such developments cannot be achieved overnight, but the House will agree the Department is progressing well and is fully committed towards these ends.

These developments are taking place in the wider context of developments in services for older people. An interdepartmental working group was established to review several complex and fundamental policy issues in long-term care for older people. Some of these issues were the subject of the Mercer report on financing long-term care and the O'Shea review of the nursing home subvention scheme. Following consideration of the group's report, a series of key principles to inform policy were endorsed by the Government and incorporated in the new social partnership agreement, Towards 2016.

These principles include, for example, that there should be one, standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised while sheltered housing options will be encouraged. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should be indifferent as to whether that care is in a public or private facility. The financial model to support any new arrangements must also be financially sustainable.

The agreement also describes a range of initiatives covering new arrangements for residential and community care for older people. Progress to date in progressing actions in the long-term care report includes the HSE developing a national standardised care needs assessment and a standardised financial assessment process for home care packages. A needs analysis of residential care requirements for older people has been finalised by HSE. National protocols for case management for home care packages are being developed by the HSE as part of the guidelines' roll-out. A planning exercise on staffing requirements for future developments for older people and the disabled is being undertaken by Department of Health and Children and the HSE. A cross-departmental team on sheltered housing will be established and chaired by the Department of the Environment, Heritage and Local Government. Work will include other groups such as the disabled. A steering committee will be set up to begin the preparatory work of evaluating the effectiveness of the additional home care packages.

Work is continuing on the development of a financially sustainable system of funding long-term care. Standard consultation with carers' representative organisations, on a cross-departmental basis, will be led by Department of Social and Family Affairs. The interdepartmental group has continued to meet to assist in drawing up proposals for a new policy on long-term care, based on the principles endorsed by Government and the social partners.

Deputies will agree these measures on elder abuse and the continuing work in developing a new policy on long-term care, as well as the budgetary and other measures outlined by my colleague the Minister of State, Deputy Brian Lenihan, outline the Government's commitment to improving services for older people.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Not one of the two Ministers of State from the Department of Health and Children addressed the key issue of Leas Cross and Professor O'Neill's report on it. Their speeches were the reiteration of recycled words which mean nothing. The truth is that until legislation covering nursing homes, promised as long ago as 2001, is introduced, we will not be able to provide our elderly people in nursing homes with the protection they need. All the waffle from the Ministers of State does not address the key issue. There were no words of condemnation from the Government on what happened at Leas Cross. There were no words of concern about the deaths at Leas Cross. There was no concern that on average people in other nursing homes lived up to 44 months after entering while in Leas Cross the average was seven months. The Government is inept and it does not care. It has been in power too long. It has failed to implement the changes it promised and it does not have the guts to take on the bureaucrats who are trying to hide this report and prevent it from coming into the public domain.

I understand there are precedents for bringing into this House reports that may allegedly cause problems. Deputy Paul McGrath reminded me of the report into the Dublin and Monaghan bombings, which was published through a committee of the House. Other examples include the Kelly Fitzgerald report and the Ferns Report. The Leas Cross report is about people who died, many of whom were moved to this facility from the care of the State in St. Ita's Hospital. Others were moved to Bedford House. Their deaths are a grave concern to everybody involved.

Professor Des O'Neill has described the report as a damning indictment of the system and of the Health Service Executive. The Government has failed miserably and utterly in discharging its statutory duty of care and protection to these most vulnerable people. This country consists of two Irelands. One of these is the wealthy Ireland comprising the business people who can support the Taoiseach by giving him money and the developers and politicians who appear at tribunals. The other Ireland, the hidden, dark side of our country, is seen in the many selfish people who are concerned only with looking after themselves and in the lack of care and respect for elderly people. This is not to say that many good people who work hard do not place family members in the care of nursing homes.

Professor O'Neill's report identifies the issues clearly and accurately both in terms of administration and in regard to the absolute system failure in the Health Service Executive northern area. The truth contained in this report is crying out for recognition because it is the voice of the people who have suffered. It is what we must listen to and know. It is what is being hidden, what the Government does not intend to publish because it lacks the will, courage and interest. The reality is it could not care less. Thankfully, this report will see the light of day because we have an Information Commissioner who put pressure on the system and the Government, even though that Government changed the law to make it more difficult for the truth to emerge. The truth will out and the longer the Government continues in office the more negligent it will be because it still has not produced the necessary legislation.

Our motion refers to the failure of the Government and the broken promises of the Taoiseach and the Minister for Health and Children to introduce legislation in this area. In a debate in 2001, the then Minister of State promised such legislation but nothing has been done. Concerns were expressed in the Dáil by Deputy Kenny early in 2005. Of particular concern was the case of Mr. Peter McKenna who was admitted to St. Michael's House against the wishes of his family. How could this happen? Why was no way found to meet the needs of this family who felt so strongly that their relative should not be put in this home? Where was the energy and drive to question and address the situation in Leas Cross? Where is the effort to protect and support such people?

We know from a recent episode of "Prime Time" that the family of Peter McKenna has had little satisfaction from the HSE. The Minister, Deputy Harney, met family members and offered her support. Will she now take the necessary steps to ensure they get comprehensive answers from the HSE and St. Michael's House? Will the Minister take responsibility and appoint a third party to assist them in their efforts?

I have files of information that leave me in no doubt there are other nursing homes in which the same problems exist as those in Leas Cross. It is strange, however, that when I wrote to the Department of Health and Children some years ago on this issue, it seemed to have no files. On 31 May 2001, when I was a Member of the Seanad, the then South Western Health Board wrote to me in reply to a request for information under the Freedom of Information Act in relation to copies of nursing home inspections where significant breaches of the regulations were noted. Some 12 nursing homes are mentioned in this letter but I will refer to only four of them, Bedford House, Fairways, Rostrevor and Rathfarnham. Almost five years later, three of those remain open and still represent cause for concern.

I called for an investigation into Bedford House in this House some time ago. It was giving rise to concern at that time and the situation remains the same. I am in possession of a file on the facility, which runs up to 2005, and it is clear no changes have been made to address these concerns. The law requires every nursing home to have a matron or other similarly qualified person in charge who must work full time in that home. However, the matron at Bedford House was, at the same time, also in charge of another nursing home in Castlebellingham in a different health board area. How did this happen? How can the Minister of State stand over his speeches today when he has failed to investigate such basic issues, which the health board identified five years ago?

When I received the file on the Fairways nursing home, which I have in my possession, it was closed. I examined some coroner's reports relating to deaths that took place there, which I have in my office and will be glad to give to the Minister of State. Before that nursing home closed it was bought by a couple who put a Montessori teacher in charge of the residents. The home was run for some months by that person who had no medical qualifications. A report on one death indicated that the health board insisted on the appointment of a matron and a suitable person was eventually appointed. The Department's inquiry must include an investigation of this issue. The coroner's reports also showed that files on all the patients in this nursing home were destroyed. These events took place under the Minister of State's watch.

The Minister of State's promises are seen to be absolutely hollow when one considers the case of Rostrevor nursing home. The then health board went to the High Court to close this home because of its deep concern for the quality of care it provided. The court said the board did not have the power in law to seek its closure through the court. The judge's decision was that the law was not strong enough to offer that type of protection. The health board had to return to the District Court and approximately one year after the initiation of the prosecution, it secured a fine of €8,000 against the nursing home. I am not sure how long the Minister of State has been in office but the law was shown by the High Court, more than a year ago, as inadequate to allow the State to close down a nursing home that was acknowledged as appalling and unacceptable.

Rathfarnham nursing home was another facility that was significantly breaching the regulations in 2001. Last year, a medical doctor who inspected the home wrote to the health board that he could no longer stand over the continued operation of the home because of the quality of care within it. This is the home where two patients were buried without death certificates. A successful prosecution was brought against it for breaches of the Food Hygiene Act. This facility must be investigated with the same level of forensic analysis as Professor O'Neill used in examining Leas Cross.

The message for the Minister of State and the Government is that there has been a consistent systems failure for some years, both legally and practically. The law does not allow the Minster of State at the Department of Health and Children to close a bad nursing home. There are many nursing homes similar to Leas Cross. I have a list of nursing homes where time and again the inspector recommended a nursing home be closed and requested legal advice. This recommendation and request is repeated year after year. These homes happen to be in the Kildare area. I do not mean to imply anything by this because I do not know their names.

There was a case in Kildare of a nursing home with no food. The same occurred in Kilkenny — not a packet of cornflakes, a bowl of porridge nor a pint of milk. This is what is going on. I only know all this because I used the Freedom of Information Act.

The Government knows what is going on because it changed the law. It changed regulations to make it more difficult for people like me to get information on nursing homes. The Government is hiding behind bureaucracy, failing in its duty of care and failing to provide transparency and openness. On moral issues of care and concern, looking after those most vulnerable, it has utterly failed.

One can study any county and find the same failures. This is not to say that there are no excellent nursing homes. We should support those homes and put them up in lights. People should see inspectors' reports on the Internet which will indicate which homes offer the best quality care.

There are many fine nursing homes. There is one in my county of Louth. Every year they invite the whole community to come in, and they have families visiting and a band playing. They encourage intellectual activities and provide physiotherapy. Nowadays many nursing homes are full of people staring into space owing to a lack of stimulation. Such homes lack services. People are left to rot and die in many cases because the effort is not expended to provide services like plant therapy, gardening and pet therapy. How many old people would find a pet a comfort? We are failing in our duty of care. We are utterly, totally and abysmally failing.

The message is clear: "Prime Time", RTE, The Sunday Independent, The Irish Times, the Irish Independent and the Irish Examiner take up these issues when they can, provided we are not in a crisis, like tonight, over other issues. The focus is once again on the quality of care provided to the elderly and the lack of action, care and concern from this Government.

I recently received a complaint about another nursing home. It was a sad case because the lady involved, who had suffered a stroke, was forced from her bed to have a shower. She was brought down to have a meal while very upset and, unfortunately, passed away. The staff were told not to mention the incident to anyone.

There are people in distress in many nursing homes as we speak. I know of another home where a patient was visited by a nurse. The nurse noticed that his leg looked bad, it was going black and gangrenous. She recommended he be taken immediately to a hospital. His leg was amputated and he would have died if he had merely stayed in the home.

Questions hang over the medical profession — not whether they are failing to do their best, but what criteria are in place. What standards do the Irish Medical Organisation and other professional bodies apply regarding checklists for doctors working in nursing homes? There is an issue that arises often relating to drugs not being signed off by a doctor. Often the doctor lives some distance from the nursing home and a repeat prescription is provided, but the patient is not always medically examined.

There are issues relating to the role of nurses. Medical professionals are excellent in most cases but not all. I would like to hear from those working in the homes mentioned, those who have not done their jobs. The extension of this law requiring greater transparency on nursing homes is a good thing.

Inspection reports are published on the Health Service Executive website. I will not name the homes involved, there are not many of them, but I am pleased that the practice has commenced. There were 27 patients in one of the homes mentioned. The first sentence states the inspector agrees the number of residents can be increased to 29. That sounds fine until one reads further on. It is stated that there are not enough staff on duty in the home and more trained personnel are required, especially at night. This is contradictory. How can a nursing home increase its number of patients while those patients are not receiving the quality of care they require?

I have grave concerns because I do not see any quality control. Other reports are a complete whitewash. Homes with 100 beds, similar to Leas Cross, are covered in a single page stating it meets most, not all, the legislative requirements. That is not a satisfactory inspection report, especially if it is not signed. There is not enough detail. I acknowledge that things are changing slowly but we need much more action.

The issues have not changed in five years. This Government has neglected its duty of care to the elderly and has not addressed the issue tonight. Government speakers have mentioned neither Leas Cross nor Professor Des O'Neill. This Government is offering only silence, stonewalling and secrecy on the issue of nursing home care and care of the elderly.

The report by Professor Des O'Neill is in the hands of the HSE at the moment. One of the people in charge of examining that report is named in it. I do not think that person should be involved in deciding whether the report should be released, however tangentially he or she is mentioned. This must be addressed immediately because it is unacceptable.

The public will not allow this Government's failure to continue. Unless this legislation is brought in immediately, vulnerable people in nursing homes throughout the country will go without protection. Many cannot speak for themselves, many suffer from Alzheimer's disease and many have no relatives visiting them. The change must come.

I acknowledge that a Bill is coming before this House next week offering voting rights to prisoners and I have no problem with that. However, I have a problem with the fact that this legislation on nursing homes does not predate that Bill. It is far more important to give priority to proper care for the elderly than to voting rights to prisoners, although I do not have a problem with the latter.