Thursday, 28 September 2006
Private Members' Business
Nursing Homes: Motion (Resumed).
I am glad to have an opportunity to make a brief contribution to the debate on the release of the report on the Leas Cross nursing home saga, which is an important matter. Many Deputies recall the appalling footage we saw on our television screens some months ago, when an RTE documentary highlighted the lack of care given to elderly people who were residing in Leas Cross nursing home at a heavy cost to their sons, daughters and loved ones. I am sure what we saw on that occasion was the exception rather than the rule. I would like to think that is the case. All of us are aware of private nursing homes in our constituencies which offer a tremendous level of care to elderly people. Such nursing homes should be commended for the care they offer. That care comes at a great expense to many people, however, as I have said. I feel very strongly about this issue.
Legislation is being brought through this House to put on a statutory footing the scheme whereby the relatives of those who were cared for in public nursing homes and hospitals will receive repayments. I am familiar with the level of care that has been given and will continue to be given to elderly people. There is a stark difference between public care and private care. As a result of a court decision, the State has to refund many millions of euro to people who have not asked for such moneys. The vast majority of such people are more than satisfied with the level of care that was offered in public hospitals and nursing homes. Many of my constituents contact me through my constituency office and at my clinics to ask me if I can help them to place their elderly relatives in public hospitals and nursing homes. I cannot interfere in such cases, unfortunately, as I have little influence on the clinical decisions made by the hospital managers and the consultants who care for elderly people.
The State has to pay back substantial moneys. I understand, from what I have heard, that many people who are entitled to get money back are refusing to take it. I suggest to the Minister for Health and Children that such moneys should be directly repaid in enhanced subvention. Members of the House have spoken in recent days about the discrepancies in subvention between the former health board regions. It is something that needs to be reviewed and regularised so every member of the community can compete on a level playing pitch, regardless of where they reside. I know of many people who are at their wits' end because they are trying to put their children through college. While there may be four or five children in a family in some cases, just one or two of the children take responsibility for paying for their parents' care. The financial gap between the money available from the parents' old age pensions, with the subventions they get from the State, and the money needed to finance their care often needs to be bridged on a weekly or monthly basis by the children of the people in question. I would like the Government to make a greater effort to allocate more funding and resources to enhanced subvention. As legislators, we should recognise the great financial need that exists in many cases. That is more important than being obliged by law to recognise the needs of people who were very well cared for in public nursing homes to receive repayments.
Those of us who saw the footage from Leas Cross had never before seen such footage from inside a public institution and I believe we never again will. It spoke volumes. I do not want to be negative — I hope Leas Cross was an isolated incident.
What we saw was appalling, but an investigation has taken place. It is right that we should want to know the results of that investigation as quickly as possible to ensure we do not have a repeat of the Leas Cross incident. It is important we acknowledge the results of the investigation and deal with them at the earliest possible time. However, the Health Service Executive has stated that if the report is published, the matter could end up in the courts. None of us would like that to happen because it could cause the process to be delayed for months or even years. Sensible solutions have to be found. All of us have a responsibility to ensure that what happened at Leas Cross is not repeated. The lessons which have been learned from the Leas Cross incident must be put into practice to ensure that those elderly people who need it can benefit from a proper, decent and good level of nursing care. It is the least that such people deserve, having made an important contribution to society.
Like Deputies Cregan and O'Dowd and everybody else, I was horrified by what happened at Leas Cross. I am sure Deputy Cassidy, who will speak after me, shares those feelings. I am sure there were other nursing homes which were just as bad.
Having said that, we all know that great work is being done in many nursing homes throughout this country. Great work is being done for elderly people in my home county. I refer to the nursing home in my home town and many other nursing homes across County Meath. Some of my constituents stay in nursing homes in neighbouring counties. I know of a person from my constituency who was resident in a nursing home in Deputy O'Dowd's home county of Louth. Some of my constituents are staying in places like Virginia in County Cavan. A few of my good friends have resided in the nursing home in Castlepollard, which is in Deputy Cassidy's constituency. I am sure the Deputy will speak about that beautiful nursing home.
Indeed. I would like to refer to St. Joseph's county nursing home in Trim, County Meath. I have been friends with many of its residents since the time when Meath County Council used to hold its Christmas meetings at St. Joseph's. I have seen the great work that is being done at St. Joseph's, which serves all of County Meath. The marvellous work being done for elderly people in Trim is a credit to the nursing staff of St. Joseph's and particularly to the matrons and former matrons there. However, we cannot turn a blind eye to the failure of some nursing homes to do such great work. We are glad that such shortcomings have been highlighted and we hope they will be stamped out for once and for all. As we saw on our televisions and read in our newspapers, some poor and unfortunate people, who contributed significantly to the economy and made this country what it is today, have been subjected to disgraceful treatment. We must never lose sight of the fact that many people who are now in nursing homes worked in difficult times, when there was no such thing as a booming economy. Many of them went to work on empty stomachs. They worked hard to build the country. It is sad those same people have been neglected in some nursing homes. Shame on those who allowed this to happen.
This year an additional €20 million was allocated to the nursing home subvention scheme for residents of private nursing homes. This represents an increase of 14% over 2005, an estimated spend of €140 million. This additional €20 million will go towards supporting increasing numbers entitled to basic nursing home subventions, reducing waiting lists for enhanced subventions and bringing greater consistency to the different levels of enhanced subvention support.
Regulations were recently made to make the assessment criteria for subventions, not updated since 1993, reflect major changes in property values. The property ceiling that was set at €95,000 in the Nursing Home (Subvention) Regulations 1993 will be increased, having regard to the Department of the Environment, Heritage and Local Government house price indices, to €500,000 for the Dublin area and €300,000 for the rest of the country. The assets ceiling will also be increased to €36,000 from €25,359. Previously, the first €7,618 of an applicant's assets would be disregarded when applying for a subvention. It will be increased to €11,000.
How much time have I left?
With regard to the principal private residence of an applicant, the new criteria will take into account whether it is occupied by a relative of an applicant who is, for example, a spouse, a child under the age of 21 years or in full-time education, or a relative in receipt of certain Department of Social and Family Affairs payments. Where an applicant's principal residence is not constantly occupied by a relative, the HSE shall exclude 95% of the estimated market value of the principal residence from the financial assessment of the applicant and where 5% of the market value of the principal residence shall be taken into account. The Bill provides for this percentage to be amended by way of further regulations so that a high percentage of a principal residence will be excluded from the assessment.
The interdepartmental group on long-term care reported to the Government which took on board several principles contained in the new social partnership agreement, Towards 2016. The agreement described a range of initiatives covering new arrangements for residential and community-based care for older people. Progress to date in implementing 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 the 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 the 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, a new scheme whereby those in private and public facilities would be eligible for the same level of State support, rendering the system more equitable. The new system will propose appropriate levels of co-payments by care recipients based on a national standardised financial assessment. Standard consultation with carers' representative organisations, on a cross-departmental basis, will be led by the Department of Social and Family Affairs.
The Leas Cross nursing home experience is a serious issue which is alarming and worrying. It is one that all Members wish never took place. It is a wake-up call and Members must do their duty to ensure the same never takes place again. Having served on the Midland Health Board for over 18 years, I acknowledge the great work done by the nursing and professional medical staff in caring for all patients and improving standards immensely, compared to what they used to be many years ago.
The cherished people in our community are our senior citizens. These are the parents and grandparents who did not experience the buoyant economy we now have. They encountered many difficulties from the First World War, the Rising, the Civil War, the depression, the Second World War and other challenges. These people, now in their 70s, 80s and 90s, the autumn of their lives, should be enjoying their retirement in comfort. Members get no pleasure in seeing how they can assist the Minister for Health and Children and her Department in addressing the experience of Leas Cross nursing home. We must be thankful to the RTE investigative team which brought this experience to the knowledge of Members and the public which proved what we were witnessing was not hearsay or some allegation but a fact.
The people about whom we are speaking are the cherished generation. Members on all sides of the political divide want to do all they can for them, especially in this time of plenty. The economy cannot be blamed for lack of action. When I became a Member of the Oireachtas in the 1980s, representing rural areas of counties Westmeath and Longford, it was often said that many objectives could be achieved were it not for the dreadful shortage of money. We can no longer use that excuse because money is now available. A particularly sad aspect of this matter is that there are currently 100 to 150 bed vacancies that could be filled if the correct structures were in place to allow people avail of the facilities to which they should have access. With careful planning, such facilities would be available in the north County Dublin area.
Deputy Cregan mentioned the subvention for the elderly. My experience with constituents in the midlands suggests that the subvention must be examined and addressed seriously. The Minister for Finance, Deputy Cowen, who is a former Minister for Health and Children has vast experience in this area. I hope he will, in the forthcoming budget, seriously examine the regulations in regard to this subvention. One must be almost penniless before one can avail of it. The full subvention seems to be given only to people who have no home in their name, practically no money in the post office or bank and are confined to bed and unable to move around independently. Unless he or she is in dire circumstances, a person of 80, 90 or even 100 years of age will find it difficult to qualify for the full subvention. The excellent staff of the HSE have little discretion in this matter but must follow the regulations. A person with any more than €20,000 and a small cottage, for example, is not entitled to a subvention. This situation is unsatisfactory. Patients always live in hope that they will recover and be able to return to their own home.
The carer's allowance currently amounts to €180 per week. A decent increase in this payment might allow people to take time off work to look after an elderly relative in their home. In such cases, the elderly person would have no need to go to a nursing home. Carers are one of the groups of unsung heroes in our communities. I have often said such people should get a gold medal for the sacrifices they make and their dedication to the communities they serve. They are fantastic people. Now that the economy is strong, we should show our appreciation by including in the next budget a substantial increase in the allowance. In many instances, people would not have to go to a nursing home if such an increase were granted and a substantial discretion allowed to HSE officials in local areas in assessing their needs. Perhaps two carers could be assigned to look after a person in his or her own home, for example, one during the day and the other at night.
We are fortunate in Westmeath and surrounding areas to have many magnificent facilities such as the Maple Court nursing home in Castlepollard, which I often visit, the St. Camillus centre in Killucan, the Newbrook nursing home in Mullingar, Portiuncula Hospital, and the facilities in Multyfarnham and Tyrrellspass. The proposition before us today is one from which we can all learn. We may show our determination in this regard by assuring the Minister of State, Deputy Seán Power, that he will have our support should he seek increased funding from the Minister for Finance in the forthcoming budget.
I propose to share time with Deputy Fleming.
As is traditional on these occasions, I thank the Fine Gael spokesperson on health for his work on this motion, which gives us an opportunity to discuss this important issue. I compliment the work of the Minister of State, Deputy Seán Power, in this area. It is good that we in this House should reflect public concerns about this issue.
I have just come from a meeting of the Joint Committee on Health and Children which was attended by the Minister for Health and Children, Deputy Harney, and the chief executive of the HSE, Professor Brendan Drumm. I got more excited at that meeting than is usual for me so I am happy to come to this Chamber where everything is calm and in which I may calmly make my contribution on this serious matter.
It is important that we in this House should represent those who may not be able to represent themselves.
I have enjoyed a long friendship with Professor Des O'Neill. He tended to my father during his last illness in St. James's Hospital and he is now an eminent consultant in Tallaght Hospital where he does tremendous work. I could not but expect that his report would reflect his particular care. Members of the Joint Committee on Health and Children received copies this morning of the opinion of legal counsel on these issues. Political points have been made in respect of whether the report should be published. I am of the view that whatever is required to allow for publication should be done. That is what the public require and all of us wish to be confident that everything possible is done to ensure that the care given to elderly people in nursing homes is universally of a first class nature.
My colleague, Senator Glynn, made a fair point on this issue which reflects my experience as a member of the former Eastern Health Board, which I joined in 1994. When the health boards were abolished there was much criticism of the visiting committees and of the practice of allocating expenses to councillors. The reality, however, is that they played an important role.
As Deputy Cassidy observed, we must examine the provision of subvention. This system is not working as efficiently as it should be. The Minister of State eloquently dealt with this issue at yesterday's meeting of the Select Committee on Health and Children. He acknowledged there are challenges in this area and I hope he will ask his departmental officials to examine the issue.
I welcome the opportunity to contribute to this debate. I compliment the Minister, Deputy Harney, and the Minister of State, Deputy Seán Power, on the improvements in the funding of services for elderly people. I have three points to make and I ask the Minister of State to take note of them. I have heard there are difficulties in Laois and Offaly relating to travel expenses for those who approve people for home help. People in need of home help in this region are not receiving it. I was told last night that the next meeting between the union and the Health Service Executive is scheduled for the end of October. It should happen now. The difficulties need to be solved because people are suffering while the home help issue is being addressed.
I welcome the meals on wheels service. However, I was involved with the Chairman of the Committee on Finance and the Public Service in highlighting the fact that commercial operators are providing this service in some cases and those in receipt of the service are obliged to pay VAT. This is an anomaly. There is no VAT on services for children's crèches and there should not be any charged to people receiving meals on wheels. Discussions are taking place between the Department of Health and Children and the Department of Finance and I ask that they be brought to a conclusion. If this requires legislation then it should be dealt with as soon as possible.
I approach the issue of Leas Cross nursing home as a member of the Committee of Public Accounts. I welcome Professor Des O'Neill's report. Who owns this report and has the intellectual rights to it? If Professor O'Neill has the intellectual rights then it is not the property of the HSE. If the HSE has the rights to it they are free to make amendments to it unilaterally without consulting Professor O'Neill. It seems these issues were not satisfactorily addressed when the contract for the report was written. This happens throughout the public service. Those drawing up commercial contracts with outside individuals do not always do what is required. It seems that either Professor O'Neill or the HSE has the right to issue the report or make amendments.
I welcome the additional support and funding the Minister for Health and Children will provide in this area.
This morning the Tánaiste said the Progressive Democrats believes in accountability, though he refused to answer two of my questions regarding payments received by the Taoiseach from sources in Manchester. Had his privacy legislation been in place, the recent stories relating to payments to the Taoiseach would not have emerged. The purpose of that legislation is to protect the most powerful and wealthy people in society. I believe this is the function of the neo-conservative Progressive Democrats. There is very little accountability.
This is a preamble to my pointing out that the situation in Leas Cross, and nursing homes in general, stems from a lack of accountability. A report conducted by an eminent professor, who lives in my constituency, has been suppressed. Power was vested in him to make an assessment and he did his job thoroughly. This was not a form of tribunal. Of course, the findings of his report were not to the liking of certain people in powerful positions. The HSE is protecting individuals when it ought to protect the most vulnerable people in society, the elderly. The HSE's priorities are wrong.
The point made by the previous speaker is valid. We must consider who owns this report and what were the terms of reference. Professor O'Neill has done his job well and, as far as he is concerned, that is the end of the matter. He will not return to make amendments. We should listen to what he says.
There are major questions concerning accountability in our health system. I was recently made aware of a serious case of malpractice and negligence which raises the issue of recourse open to relatives. It seems to be a closed shop. Had it not been for RTE's investigative journalism we would not have seen the appalling conditions in Leas Cross.
Leas Cross was not an isolated incident. I put it to the Minister for Health and Children recently that many nursing homes received adverse reports. The Minister of State at the Department of Health and Children, Mr. Seán Power, said he would produce the relevant report and give me the names of those nursing homes. I still have not received it for the same reason Professor O'Neill's report is being suppressed. We may refer to natural justice and giving people an opportunity but these people must be held to account. It is a feature of society that those who behave badly are not held responsible.
The most vulnerable people in society have been treated like a commodity to assist in generating as much money as possible. I have heard stories of people refused a glass of milk when thirsty and given a single slice of bread spread thinly with margarine. These are all cost saving measures that have been used. People have been heavily drugged and put to bed early so they would not cause trouble at night. They may be left to lie in their own urine. These are appalling stories, yet they continue. The suppression of this report is further evidence that the Government, so wedded to the market and profit, will allow this to continue.
I am sharing time with my colleagues, the Independent Members. I thank Professor O'Neill for his work and I hope his report is published as soon as possible.
I will share time with Deputies Finian McGrath, Healy, Connolly and McHugh.
Tugaim tacaíocht iomlán don rún mar a bhí sé curtha síos, agus tá mé i gcoinne leasú an Rialtais.
The Minister for Health and Children stated the Government amendment repeats that the Leas Cross report cannot be published because of legal difficulties. I gcás tuairiscí eile, mar shampla, an ceann ón Ghiúistís Barron ar bhuamáil Bhaile Átha Cliath agus Mhuineacháin agus ionsaithe eile sa Stát seo a dhein Rialtas Shasana in éineacht le dílseoirí, rinneadh cinnte de gur foilsíodh iad i ndiaidh dóibh bheith curtha ar aghaidh chuig coiste cuí an Oireachtais. Dhein sé seo cinnte de go raibh na tuairiscí seo clúdaithe ag pribhléid Dála, agus lig sé do na coistí sin déileáil le hachainíocha ó dhaoine eile ar bhonn na dtuairiscí sin.
I see no reason why Professor O'Neill's report on Leas Cross cannot be published in the same manner as that outlined. Has the Government considered this option? I urge it to do so and publish the report in the manner I have suggested. The non-publication of this report means we are debating in a vacuum. It is almost unprecedented that the author of a report commissioned by the Government has had to issue a public statement urging its publication. It has been with the Minister for Health and Children since May. Why is the Minister now telling us that she believes a way can be found to publish this report? What has she been doing since May? The report should have been published a long time ago. Professor O'Neill correctly pointed out that he cannot now be expected to carry out a further investigation going beyond the terms of reference of his original investigation because of the refusal, so far, of the Government to publish his report.
When we first debated the Leas Cross scandal, Deputy Ó Caoláin, on behalf of my party, stated in this House that the questions in people's minds after the "Prime Time" programme were very simple. Why did all the organs of the State fail to protect those vulnerable old people? Why did it take a television programme to expose the scandal when such homes were supposed to be governed by the rule of law, bound by regulations and subject to inspection? In the absence of the publication of Professor O'Neill's report, we still do not have answers to those questions. Vulnerable older people and their families are still concerned about the level of protection they are offered by the State. The Government has failed to fulfil its commitment, given by the Taoiseach and the Minister for Health and Children, that an independent nursing home inspectorate would be established. That inspectorate was promised by the Government for 2005 but is still not in place. That is a scandal in itself.
The former profiteers of the Leas Cross nursing home benefited from tax incentives for the development of that facility. Tax incentives have been used by many developers to build such facilities and we challenge the use of public money in this way. The Department of Finance report on tax incentives asserts that this tax incentive scheme was one of the factors leading to an increased number of nursing home places. However, it also states: "There is considerable variation across different regions in the number of nursing home beds per capita, the costs to the operator per bed, the rate charged per bed and the average occupancy rates." The report further states:
The weekly cost of places has risen over the last number of years. Indecon survey evidence suggests that the tax incentive scheme had been ineffective in reducing the increase in the cost of nursing home accommodation.
This clearly shows the flawed Government approach of using tax incentives for developers as a means of delivering an important social service, that is, care of the elderly. The money foregone by the State through such tax incentives would have been better spent in direct provision of care for the elderly in the home, in day care centres and in residential homes established and run by the Health Service Executive and by not-for-profit organisations.
I support the motion and oppose the Government amendment.
I am grateful for the opportunity to speak on the Leas Cross nursing home and the wider issue of the elderly. I strongly support the call for legislation to provide for an independent, statutorily based inspection regime for all nursing homes and for this legislation to be brought forward as a matter of urgency. I also support the motion's call for all inspection reports to be made directly available to residents of nursing homes and their families.
However, I warn the large parties with regard to past mistakes. I accept and acknowledge that there are some legal difficulties in the HSE publishing the Leas Cross report. I warn all parties to take note because in the past, major mistakes have been made and hundreds of thousands of euro of taxpayers' money was spent because of serious mistakes and bad legal advice. In that context, I urge caution.
I wish to raise the issue of the bureaucratic delays for all pensioners and elderly citizens, of 14 to 16 weeks, in having the pension and bus pass claims processed. I raise this matter today because elderly people must be supported. They built up this country and the Celtic tiger. I also urge the Minister to put more community gardaí on the streets to protect elderly people.
Our senior citizens are experiencing severe economic difficulties, limitations in access to health services and a lack of social services. They are also suffering considerable shortcomings in their housing and living conditions, exclusion from culture and education, inappropriate treatment and have scant opportunity for participation in social and political life. These forms of discrimination and inequality, based on chronological age, are experienced by many groups of older people. I urge Members to listen to the concerns of elderly people because they built this country.
I wish to record my support for this motion, particularly with regard to the inspection of nursing homes. Inspections are vitally important and the inspection regime should be statutorily based. Furthermore, inspection reports should be freely and openly available to the public.
One important issue which relates to this debate is the lack of sufficient long-stay beds for the elderly in the public system. Excellent work is being done in the public system, for example, in places like St. Patrick's Hospital in Cashel, St. Anthony's unit in Clonmel, and the district hospitals in Tipperary, Carrick-on-Suir and Clogheen in my constituency, but there are not enough beds. As a consequence, elderly people experience enormous delays in gaining access to the beds that are available. The result is that some people die before they ever gain admission to these facilities and many more are forced to go into the private nursing home system only to find there are enormous costs involved.
Let us take the case of an individual whose only income is a social welfare payment, who does not own his own home but rents a house from the local authority and has no savings or investments. The maximum subvention that individual will receive in the former South Eastern Health Board area is €250 per week. The minimum charge in a nursing home in the same area is €550 per week. If the individual concerned receives a social welfare payment of €200, he is short €100 per week, with no way of making up the balance, except to ask his relations and friends to give him a so-called dig out, similar to that received by the Taoiseach in 1993 and 1994. However, if the individual's friends are not in a position to give him a dig out, as it were, his family will have to scrimp and scrape to ensure he is looked after in a private nursing home. In that context, it is vitally important that additional public nursing home long-stay beds for the elderly are made available.
Another related issue concerns elderly people being looked after in their own homes — the Government amendment refers to this issue. Unfortunately, however, the home help service has been ravaged and reduced by the Government. The payment of carer's allowances is also an enormously difficult area. People are waiting up to six months for approval of an application for a carer's allowance. Where appeals are lodged, people are waiting for 12 months for a final decision. I ask the Minister to examine this area without delay.
In discussing the O'Neill report into Leas Cross, it is important to remember that 105 people died between 2000 and 2005, either at the nursing home itself or following transfer to hospital from Leas Cross. The families of all those people are entitled to the immediate release of the report. The Minister for Health and Children, Deputy Harney, has repeatedly told us that there are legal issues involved and that her legal advisers are examining the options. Where were those legal experts when the terms of reference for the inquiry were drawn up? Did the Minister think no-one would be blamed for anything?
The most amazing aspect of this saga is that the owners of Leas Cross have no problem with publication of the report. The report, I believe, accepts that while the mortality rate of 38% at the home was higher than expected, none of the deaths was preventable. The first draft of the report has been with the Minister since February of this year. The final report does not, as I understand it, differ greatly from the draft report, but seven months later we still await its publication. That is simply not good enough. Perhaps I should not be surprised at the delay in publishing the O'Neill report, given how long the Minister for Arts, Sport and Tourism, Deputy O'Donoghue, sat on the report into the activities of Bord na gCon. The crucial difference here, however, is that 105 people died and, while none of those deaths may have been preventable, the families of those people are entitled to know whether staffing levels at Leas Cross were adequate and whether the staff had appropriate training. They are also entitled to know if proper work practices were in place at the home and if lessons have been learned so others will not suffer what their loved ones suffered.
If the Minister cannot obtain immediate approval to publish the report, it should be released to the Oireachtas without delay. I shudder at how long it will take to implement the recommendations of the report given how long it is taking to publish it.
A national register to monitor vulnerable patients is an absolute necessity and the necessary resources should be made available instantly to maintain such a register. The recommendations to have a register, proper inspection procedures and free availability of inspection reports to residents and the families of residents require action now.
Leas Cross serves as an example of the murky side of the care of the elderly but it can also serve as a very valuable lesson on how the system can and should be reconfigured to eliminate unacceptable circumstances, such as those in which older people are treated so badly. The example of Leas Cross proves conclusively, without any report, that the inspection system is not working. The rotten apple in the pile was Leas Cross and it was not detected.
It would be reassuring to believe there are no more Leas Crosses but unfortunately we cannot say there are none. What can we do? Promises made by Government to have an independent inspectorate must be honoured as soon as possible. An inspection system is also needed for the public sector because the Health Service Executive, as a service provider, is in a position in which it can check itself.
The service should be independent. The system must ensure that proper standards of care are maintained and this should be the primary focus of any inspection system. The over-bureaucratising of the inspection process must be resisted at all costs and minor matters must be regarded as such and good endeavour must be acknowledged properly. Since the Government has abdicated the care of older people to the private sector, it is doing less and less in getting rid of public beds.
Community facilities must be encouraged and acknowledged properly. Full care for older folks, and adequately supported care are so important. While the vast majority of private nursing homes are doing a fantastic job, on foot of the State abdicating responsibility to them by closing public facilities, there is an understandable element of cherry-picking because of the heavy demands of those who need very high levels of support.
I call for a special provision above and beyond what is available for enhanced subvention for community units with no profit margin written into the equation to ensure there is somewhere vulnerable people can go to receive a very high level of support in their own community. Currently such patients often end up in hospital and are sent out blindly therefrom to institutions which do not have adequate resources to look after them properly. It is not good enough to send people from institutions without seeing where they are going and ensuring they are looked after properly.
The delay in the publication of Professor Des O'Neill's report into the number of deaths at Leas Cross nursing home is unacceptable. Relatives of those who died in Leas Cross are entitled to see for themselves the full findings of the report. We know the report was concluded as far back as April of this year and there is simply no excuse for further delaying its publication. For the Minister for Health and Children, Deputy Harney, to state the HSE should resolve its difficulties with Professor O'Neill is not good enough. She is the Minister and has direct responsibility to ensure nursing homes are safe and well run.
The sections of the report quoted on "Six One News" last Thursday certainly vindicate the content of the "Prime Time" programme of last year. They confirm that there were very serious problems in Leas Cross. We also know from a number of HSE reports and from replies to parliamentary questions to the Minister for Health and Children that serious problems and discrepancies were by no means confined to Leas Cross. This has been brought to the attention of various Ministers over the years. These discrepancies pertain to hygiene problems, staff levels, the maintenance of accommodation, poor record-keeping and the lack of equipment appropriate to clinical practices.
I could elaborate further in this regard but what is of real concern to me is that so little has been done to deal with these problems since they were first raised in this House. For example, on the day following the "Prime Time" programme of last year the Taoiseach assured the Dáil that legislation to provide for the establishment of a nursing home inspectorate would be enacted before the end of the year. Commitments were made as far back as 2002 but we are now talking about 2007. How serious is the Department about bringing forward legislation to provide for the inspectorate, which inspectorate would have improved the conditions in which people were cared for at Leas Cross?
This is no way to treat older people who rely on care in nursing homes or other institutions when they can no longer be cared for at home. The only way to ensure the highest standards are in place and are being implemented is through the establishment of a statutory inspectorate with strong enforcement powers. The present arrangement, whereby the HSE is inspecting itself, has proved to be ineffective and not in the interest of the patients.
I have a brochure from the Leas Cross nursing home which dates from 2004. One would think it was a brochure for a four or five star hotel. It outlines the rates and the medical services provided and it refers to a 24-hour doctor service and to 24 beds which were ring-fenced for residents of St. Ita's Hospital, Portrane. I refer to this in the context of a case raised by a constituent of mine. The constituent stated her 91-year-old uncle was a resident in Leas Cross from December 2002 until his death in July 2004. She visited him three to seven days per week to look after him and acknowledged the changes that were taking place during the period in question. She wrote to the Northern Area Health Board and subsequently to Professor O'Neill about the matter. She referred to the lack of care, her uncle's fears in respect of another resident, his being knocked down on the ground and the fact that, after suffering from a broken hip, he was left in bed in pain and was not seen by a doctor until 3.50 p.m. three days later. She outlined the delay in securing an X-ray. A doctor in Beaumont Hospital stated her uncle was suffering from malnutrition. These are the facts. This lady and the relatives of the 103 residents who died at Leas Cross are entitled to see the report as quickly as possible. It is up to the Government and the HSE to deal with this matter.
The Northern Area Health Board, in its letter, acknowledged that the nursing home accepted that there had been a breakdown in procedure in respect of the care of the man in question and that it was committed to improving its protocols and procedures to ensure patients would be dealt with in a timely and appropriate manner. This was ongoing. People were making complaints to the health board at the time in question. The health board also confirmed that the nursing home had prepared a new policy to ensure that difficulties experienced by the man in question would not arise again. The health board's letter concluded that its team would continue to monitor the measure put in place by the management at Leas Cross. It is clear that, well before the "Prime Time" special, relatives and friends of residents in Leas Cross had concerns, which they brought to the attention of the health board at the time. The HSE must be brought to account, since it has questions to answer. That legislation on an independent inspectorate has not been prioritised reflects the Government's lack of concern for one of society's most vulnerable groups, those no longer able to continue living in their own homes owing to age and infirmity. The failures in the nursing home sector are well known. What else must come to light for the Government to take action? That it knows of the problem but is failing to do anything about it shows a lack of priority. The current inspection process is unsatisfactory, but at least it provides some information about nursing homes.
In previous debates, I stated there was absolutely no reason for inspection reports not to be routinely made available on the Internet. Some progress has been made on that in recent weeks, but the information provided is totally inadequate in detail and substance. The current social services inspectorate has been operating on a non-statutory basis for ten years. We need legislation to put it on a statutory footing and the health and equality laws to ensure proper quality standards in all nursing homes, private and public. Nothing less is acceptable.
The motion before us calls for the publication of Professor O'Neill's report and the establishment of an independent inspectorate. I have listened to the various contributions, and no one in the House could disagree with that. It is therefore disgraceful that the Minister and the Government should decide to table an amendment. The people need the right services available for their elderly relatives and friends. Part of the problem in moving forward is publication of this report. Let us publish it and allow the Minister to introduce the statutory inspectorate for which we have been calling and regarding which the public has been given commitments for the last four or five years. Let us see action in that regard for the sake of the elderly.
I am glad of the opportunity to say a few words on this motion, which I support. I compliment Deputies Twomey and O'Dowd and the other speakers who contributed in its support; it is timely, useful and particularly important. When a report of this serious nature is compiled, I see no benefit to anyone in our sitting around and arguing legalities. There is no sense in our commissioning a report unless we ultimately do something positive about it. It is in everyone's interest for the report to be published without delay so all the information sought initially can be made available and the concerns expressed by those involved addressed.
I compliment those nursing homes that have run their show well in recent years, of which there are very many. The great majority do a tremendous job, provide great value for money, and look after patients in a very conscientious and caring way. Very often they do it for patients who require high-dependency nursing but lack the family that might provide such care. I compliment them on what they have done. Several nursing home proprietors have taken financial responsibility for extending the stay of certain people for whom it proved impossible to secure funding from the health service or whatever other source.
Having said that, there are others who have not adhered to the rules. There is a growing perception that facilities of this nature constitute an investment rather than the provision of a vital social, nursing and medical service. There is also a perception among HSE personnel that to draw attention to something of this kind is uncharitable, unworthy or unpatriotic. For some years a culture has been growing in the health service of refusing to listen to the obvious. We have all heard about haemophiliacs over the years, the reports, legal challenges and counter-challenges, and all the time and energy that went into their case.
Deputy O'Connor mentioned something a few moments ago regarding the old health boards and the job that they did for 30 years. They were supposed to do the job. They were abolished, having been used as scapegoats in the run-up to an election because the health services found themselves in difficulties. The Minister of the day decided to abolish the health boards to show the public his deep concern at the problem; we now know that it was no such thing. Let us remember that in the period from 1970 there was an inspectorate like the visiting committees in the health boards that did the job it was supposed to do for nothing. The difficulty was finding people to join visiting committees and give of their time. It was regarded as a great thing if one was in time for one's tea. That was an added bonus, as I well know, since I did it. With many people, there developed over the years a culture that one had to be nice to everyone. If one did that, it was thought that everything would be all right, but that is not true.
I remember sitting in this House with other Deputies many years ago and bringing the kind of carry-on current in some health board institutions to the Minister's attention. That was how the system was supposed to work; information was to percolate upwards through the system. It was only right and had to continue, although we were not popular for doing it. I do not wish to apportion unnecessary blame, except to say this. In the HSE today there is a new system, which I regard as closed and bureaucratic. It is not working in the way originally intended. I never believed it would work, but that is irrelevant. Abolishing the health boards was an abnegation of the democratic process, and their replacement is not yet visible.
I also wish to mention the great number of people who are dedicated health workers, in both public and private sectors. They do a tremendous job and display a vocational commitment that carries right through. That commitment will always ensure they do the job to the best of their ability and stand over what they do. They will be very quick to respond to any request for clarity at all times.
However, there is a growing culture throughout the system whereby such vocational devotion does not seem as visible as previously. There seems to be more reference to filling the job from 9 a.m. to 5 p.m. than to the completion of the task originally intended. One cannot walk off the job if a patient is in need of care. I am not saying that it happens, but it certainly would not have occurred previously owing to the degree of commitment.
As always, society is judged by how it treats the vulnerable who depend on it, whether the very young or the very old. That responsibility falls on us at all times, but particularly when the country is thought to be overflowing with money. It is supposed to be gushing out from everywhere. There is so much money that one Minister said that the Government did not need it any more. At this juncture, it is absolutely imperative that the highest standards, including regarding accountability, apply. There is no need to be at all embarrassed if someone asks whether the relevant standards are being applied, and no need for anyone to get upset or worried. There should be no reason; nor will there ever be.
There is no question that what happened in Leas Cross was the result of system failure. It is not the case that procedures were not in place or standards not applied. If the system had been operating as intended, the problems would have been spotted and a report compiled. There would have been no question of any legal interaction. There is no necessity for it. The challenges would be made on time. I do not know why we have got to this stage. The problem now is to reassert control to ensure the highest standards are applied at all times, not just some of the time. Remember, that applies throughout both the public and private sectors. incidentally, I recall many years ago there was a suggestion that standards in a hospital which was not the responsibility of the health board were not up to scratch. It was quite clearly pointed out that the same standards applied right across the system, inside and outside; there was no sense in having health Acts and laying down standards unless they were applicable across the board.
The importance of this debate should not be underestimated. In particular we should emphasise that we should learn from the lessons the debate highlights and initiate the inspectorate that has been promised. The Government amendment is appalling. It is the lamest excuse I have ever seen, put into print. This is no reflection on my colleague, the Minister of State, Deputy Seán Power. I am sure he agrees with me. However it was compiled or on what basis, I cannot believe it. It is barefaced, incredible. To produce that, one would need to have a neck like something else.
I will not say it, but I cannot believe that this has been put into print. I support the motion. I am amazed it has taken this long to drag out the publication. As regards the health services, delay or procrastination in evidence over a number of years are not in the interests of obtaining the highest quality of standards and should be looked at again carefully.
I again compliment those within both the public and the private health services who have done a good job. Those who do a good job whether in the public or private sector and who go out of their way to give a good service towards achieving the highest possible standards have been let down by those who do not. Unless the people whose task it is to enforce the standards do their job, the whole country is being let down, including the Houses of the Oireachtas and all the institutions.
I support the motion. I ask the Government to withdraw the amendment. I accept the spirit and the letter of the motion and the reasons for which it was put.
I have listened to the debate last night and today and, to be honest, I found it useful and a number of the suggestions were quite helpful. I would, perhaps, single out Deputy Finian McGrath for the measured response in his short contribution. I also acknowledge the research done by Deputy O'Dowd and the commitment he has shown as regards the provision of care in nursing homes. It is normal that the difficulties that arise in the system are those that are highlighted here. We must be careful, however, not to frighten old people and indeed their families. In my experience the majority of homes are well run and good care is provided. Our job is to ensure that the highest standard of care is provided not just in the majority of homes but in all homes.
The Government is firmly committed to developing and improving services for older people. Last night, my colleagues, the Ministers of State, Deputies Brian Lenihan and Tim O'Malley, outlined to the House the unprecedented levels of investment specifically targeted at improving services for the older population and directed particularly at keeping older people at home. I am happy to have the opportunity to respond to some of the issues raised in last night's debate and to update Deputies on the current position as regards the report on Leas Cross nursing home.
Deputies will be aware that the HSE asked Professor Desmond O'Neill, a consultant geriatrician in Tallaght General Hospital, to write a report for it on the deaths of residents at Leas Cross. The report, based on documents only, in line with the terms of reference agreed with the HSE, was submitted to it earlier this year. At this stage before publication, it is not appropriate to go into details on either the contents of the report or the difficulties expressed by the HSE's legal advisers. However, I can say that in general the concerns of the legal advisers cover the process used by Professor O'Neill in the drafting of the report and some of the conclusions. The HSE is attempting to resolve the legal difficulties with Professor O'Neill. Both the Minister for Health and Children and I want to see the report published as soon as possible and wish to have any remaining obstacles to its publication removed. I emphasise that. We can all learn from the report if it is published. Difficulties exist and I hope they can be overcome. I make the point again, however, that the HSE asked for the report. I know a question was asked about the ownership of the report, but the point must be made that it was the HSE which commissioned it.
When the television report was shown, it shocked viewers. It is a difficult decision for any family to send a loved one to a nursing home. When that decision is made, however, certain expectations are created. The programme showed us that the inspection system at that time was not working properly. The Taoiseach, the then Tánaiste, Deputy Harney, and I gave a commitment in this House to bring in legislation to make the necessary changes to ensure that people who go into nursing homes are given a very high level of care. We have made every effort to ensure that this happens and it will.
On 31 May, following the television programme on Leas Cross, I wrote to Commissioner Noel Conroy asking him to determine whether there were issues involved that needed to be investigated by the Garda. Some people have been very critical of the HSE and the fact that it has not published the report. Some might feel the HSE is sitting on the report. It must be remembered that it was the HSE which asked that the report be published. We will make every effort to ensure that it is published.
The Deputy will have a couple of minutes to speak on this later. The Chair has not given me much time today to say my few words. I have listened to the full debate and I repeat that we gave commitments to the House. As was outlined last night, legislation is being prepared in the Department to provide for the establishment on a statutory basis of the health information and quality authority, HIQA, and a social services inspectorate function as part of it. That is a commitment which will be honoured. Public consultation on the draft heads and the general scheme of a Bill providing for the establishment of the HIQA has been carried out. Included in the scheme is provision for the establishment of an office of the chief inspector of social services with the HIQA. The office of the chief inspector will be assigned responsibility for the inspection of residential services for older people, including private nursing homes. We intend to seek Government approval as soon as possible to commence drafting the full Bill. It is intended that the Bill will be published during the autumn session.
I emphasise that we have shown commitment both in drafting the legislation and in providing funds for older people, which is very much a priority with them. We shall ensure older people are given the type of care they deserve and that those who decide to open nursing homes will be obliged to give a high level of care to all their clients. It is nothing more than they deserve and we will ensure this care is provided for them.
No matter what is said in this House, the Government has utterly failed in every respect. It has failed in its duty to legislate, it has failed in its duty to give political direction to the health services and it has persistently failed elderly patients in nursing homes. Government representatives come into this Chamber and bleat about what they have done and what they will do, which is a shocking disgrace. They do not have the manners to apologise to the patients who they have let down so badly.
As I pointed out in my contribution before this, the owners of nursing homes had to publish their own set of standards because by waiting for this Government to do something, they would all get tainted with the same bad press as the minority of dangerous nursing homes. Deputy O'Dowd spoke last night about inspections carried out by the HSE year after year. What is the HSE's response? We get a letter from Mr. Aidan Browne, national director of the primary community and the continuing care directorate, defending himself in the media.
He is not worried about the patients, nor what sort of system must be brought into place, but only worried about how he is perceived. One sentence in his letter to The Irish Times was quite interesting, "Your readers can be assured that the HSE will not tolerate nursing homes operating below acceptable standards". I would like to know where Mr. Browne has been for the last nine or ten years. He must have been asleep, because he certainly is not reading the same reports we are discussing. He continues by stating "where issues are identified for follow up action, they will be actively pursued". The owners of those bad nursing homes must have been shaking in their boots when they read that, because if the HSE could not do anything for the last 15 years, it certainly will not do anything about it now. Legislators must ask who is protecting the patients. That is the question the Minister of State should be answering.
Fine Gael will bring forward proposals for a patient safety authority. It will be mocked and jeered by Government representatives. It will be dismissed by Ministers who have much to answer for regarding care of the elderly. A patient safety authority is the only thing that will protect patients. We need an overarching body that focuses on the patient. The Medical Practitioners Act deals with doctors, the Pharmacy Act deals with pharmacists, the Nursing Act deals with nurses. However, legislation that focuses completely on the patient is always put off for another year by the Minister for Health and Children. What is another year when it comes to protecting the old people in our society? All legislation that might make a difference to patients has been put on the long finger by the Tánaiste, such as eligibility legislation. She has dismissed all legislation needed to protect patients. We must all act on this issue, but this Government especially needs to do so.
Most of the failure of the past nine years has had to do with quality of life issues and social services. The Minister's record cannot stand up on this issue. She can take action and follow our lead. She can take advice from people like Deputy O'Dowd, who has made this a major issue in his political career. She should not insult the elderly with the amendments the Government has made. The major point on which she focused, the social services inspectorate, has been dismissed for another year. That is the sort of attitude taken by this Government in the care of the elderly and it is a disgrace.
I welcome the opportunity to speak. We must ensure that those who are most vulnerable, those who have contributed so much to society, namely, our parents, have the best services. That is not the case currently.
We recently received an opinion of counsel on Leas Cross nursing home and having read it, I see no reason that the report cannot be published. The opinion expresses worries about a judicial review of the report if it is published. Let there be a judicial review and let us test the system. It should be published and we can see what happens. The opinion exposes the total incompetence of the HSE in handling the issue. The level of incompetence is unbelievable and I suggest the Minister tests the system and has that judicial review so we can allow this to be debated in full.
I want to raise the issue of patients in psychiatric homes who are in need of attention. The report of the health inspectorate for this year is extremely critical of the governance of psychiatric homes. It expresses concern bordering on outrage about the treatment of patients, the control of the treatment, the disparity of treatment and the absolute need to bring some sort of order to the situation. Some 22 years after recommendations were made to close unacceptable psychiatric hospitals, nothing has happened. The sooner the Government recognises the urgency in dealing with generations of neglect in this area, the sooner something will be done. We have had so many reports on this issue, as the Minister of State knows, including four recent reports on psychiatric services and suicide. We need no more reports. We need action and implementation of the reports. We accept all the recommendations of the 133 reports made by the Department of Health and Children, but nothing is being done. Many statements and commitments have been made since 2002, yet we are now in late 2006 and very little has taken place to ensure care for the elderly.
I received complaints yesterday on the treatment of people in nursing homes. We must have inspections of nursing homes that are not flagged in advance and that can take place at any hour of the day or night. We have seen models of this in other countries, where very strict inspections occur without notice. This ensures the services in these homes are up the required standards. Given the record of the Government, one can understand that people do not believe statements that have been made over the years. Given its repeated failures in this regard, people simply lack confidence that the Government can or will do anything. Fine Gael policy will ensure, as will the joint policy to be developed by both parties, that people will be protected, their contribution to the State and their specific needs will be recognised and services that should be available to them will be available.
Earlier, while attending a meeting of the Joint Committee on Health and Children, I heard a statement regarding nursing home subventions. In the course of the discussion on nursing homes, the urgent need to examine nursing home subvention levels was raised forcefully. I ask the Minister of State to revisit the argument and to consider the points made repeatedly by several Members regarding the need to do so, given the pressures on many families to cater for their loved ones in nursing homes. On 1 January, a raft of increases will be introduced in all nursing homes. Perhaps they will be legitimate in most cases because of increased costs and so on. I ask the Minister of State to examine this issue as part of his function.