Wednesday, 18 October 2006
Why do the Taoiseach and the Government take the attitude that the elderly are so tedious and valueless? Is it because of age itself, that the elderly have in some way withered beyond their shelf life, or is it because of the vulnerability that comes with advancing years? I do not think so. It is because the damning evidence of the men and women who died and were buried from Leas Cross is too stark and too blunt a reminder for the Government to take effective action to ensure it does not happen again.
Deputy O'Dowd exposed the scandal a number of years ago, which involved a failure to report deaths to the health board and that only one in ten admissions had their weight recorded, when the correlation between weight and malnutrition is well known. Some 14% of admissions were recorded as having skin conditions and one can only imagine the wetting, the chafing and the pressure sores. There were deficiencies in pressure sore prevention and cure and in the management of swallowing disorders. An alarming number of people were nursed in buxton chairs and there were damning deficiencies in expertise, nurse numbers and nursing infrastructure. There was a systematic failure by Government, health boards and professional bodies to provide the appropriate quality of care for older people. Overall, the findings are consistent with institutional abuse on the Government's watch.
That is the O'Neill report, a copy of which I read last night and which I have with me. Listen to the author's warning: "Given the lack of structural funding, standards and oversights, the standards in Leas Cross are very likely to be replicated to a greater or lesser extent in institutions throughout the long care system." That is the bible according to Professor O'Neill. Think of how many men and women endure those conditions today, in other locations. Think of them watching a report of these proceedings from their buxton chairs or their day rooms or bedrooms, asking why the Government has not done anything about it in the past 18 months. I ask the same question.
On the Deputy's first point, this year alone, as well as the large increases in pensions and the electricity allowances I mentioned yesterday, we have provided a large additional allocation of €150 million for services for older people. We have provided home care packages, primary and community care for older people, extended the entitlement to medical cards and put in place a range of other services.
When the problems in Leas Cross nursing home were highlighted, the Government closed it, which was the best action to take, given that we were not satisfied with the standard of care of older people there. We moved all its residents to decent accommodation with acceptable standards. The Health (Hospitals Inspectorate) Bill 2006 will put the social services inspectorate on a statutory footing, as I have said previously. The Bill will also contain provisions to underpin a more robust inspectoral system. A working group was established by the Department of Health and Children when the issue arose, to prepare standards for long-term residential care settings for older people and the draft standards will be circulated to everybody in the consultation process. The HSE working group produced a report on nursing home inspections and registrations in July, and that currently underpins the process.
The HSE also proposes to employ 32 elder abuse officers and the recruitment process is at an advanced stage. The report of the working group on nursing home inspections and registrations is being implemented. Resources were identified for nursing home inspection teams and a training programme for those teams was developed. The HSE has embarked on a process of standardising inspection reports, involving doctors, nurses, environmental health officers and others.
It is not true that the Government did not act. An entirely new process, involving legislation, staff and the full implementation of the 1993 Act, has been undertaken. I have read the report of the Department of Health and Children on the issue, during bilateral Estimate discussions, and that of the HSE so it is not true to say we have not taken action. The only issue arising from the report was that not all of the teams around the country were able to work together. There were some separate teams.
Standards inspections are now unannounced. A criticism was made in the past that the managers of homes knew when environmental health officers, doctors and nurses were about to visit and would make improvements for that day only, but that will not happen any more.
That is all blather which we have heard before. The legislation for an independent inspectorate was promised in 2001 but it has not materialised. The legislation is not strong enough to close a bad nursing home. I read the report. The Taoiseach will note, in particular, that deficiencies were noted in pressure sore prevention and care, assessment and management of swallow disorders, and in documenting the use and appropriateness of restraints, which were indicative of a failure to adequately understand and progress care for those vulnerable people. What the Taoiseach has told us does not deal with the urgency of this matter. This morning these people are sitting in circles in their day rooms, their bedrooms or their Buxton chairs watching reports of this debate. Some of these people may be suffering the kind of institutional abuse that has been mentioned in this document.
I listened to a HSE official this morning saying he would be disappointed if this happened again. No official should be disappointed. An official should be sacked if this happens again and it is on the Taoiseach's watch. Only 31 reports have been published out of 450 nursing homes. Some of the reports on the websites are useless. It is hard not to conclude that there is some kind of cover-up between the Government agencies and the HSE which failed to recognise the clear warnings about this long before the "Prime Time" report was made public, and Deputy O'Dowd exposed this matter.
Why would an inspector recommend that a nursing home be allowed to increase its number of residents while noting later in its own report that there are not enough staff to cater for the current number? That is the kind of report being made on these nursing homes. Why can we not show an effective Government response for these elderly, vulnerable and frail people? Why do we not set up an independent patient safety authority which would focus on the good and the needs of the patients, and not be clouded by cover-ups between the health system and the Department to the detriment of those people?
This recalls the old medical mantra "if it is not written down, it did not happen" but this did happen and this report is a damning indictment of how the Government handled it since long before the "Prime Time" report. Will the Taoiseach establish an independent patient safety authority now and not mess with people who did not report, and covered up, in the cases of those unfortunate persons who suffered and died in Leas Cross, and possibly other nursing homes around the country?
The new HIQA Bill will be in the House next month and will govern quality standards across the health service. The factual position is that the training programme for inspections teams has been developed, resources have been identified for dedicated nursing home inspection teams, and the 32 elder abuse officers are being recruited. The working group on nursing home inspections and registrations has produced its report which is being implemented.
The inspection teams of environmental health officers tend to visit on their own. Multi-disciplinary teams of doctors, nurses and environmental health officers attend. The HSE states that in some cases where environmental health officers carry out an inspection alone, the medical officer and nurse member of the inspection teams will carry out a further inspection of nursing and medical issues as soon as possible thereafter. All inspections are now unannounced and operate under the 1993 regulations to the effect that the current registration certificate must be displayed in a prominent place in the nursing home to show that it is being inspected and is registered. These procedures take place.
I am sure most of the people working in these homes do their utmost to comply fully with these standards, if not to meet even higher ones. The new legislation will be introduced shortly. The Health Bill 2006 will put the social services inspectorate on a statutory basis and contain provisions to underpin a better inspectoral system. Any conditions attached to the registration appearing in the nursing homes registration certificate must be on display in the homes. The HSE and the non-statutory HIQA organisation, deal with all these issues in the best possible way.
I wish also to raise an issue affecting older people but not only older people. I refer to the unconscionably high increases in ESB and gas prices. Gas prices have increased by 33.8% from 1 October, in a country where, according to the report by Deloitte & Touche on regulation of the electricity sector, almost one in five Irish people is defined as fuel-poor. The Taoiseach can imagine the impact that a 34% increase in gas prices will have on older people, social welfare recipients, people with disability pensions and people on low incomes who do not receive any social welfare payment.
To coincide with this increase on the same day, 1 October, the Minister for Social and Family Affairs, Deputy Brennan, issued a formal statement to the effect that the value of the weekly fuel allowance under the national fuel scheme has been increased by €5, from €9 to €14, with a supplement of €3.90 on top of that for smokeless fuel. It is not unusual for Ministers to issue statements that are either incapable of being understood or that obfuscate or confuse. That is a cruelly dishonest statement because that €5 increase was announced in the budget last year. If one is accustomed to reading to the end of documents and does so one will pick that up.
This €5 increase was announced last year in the budget. Unfortunate older people in fear for their health, living in poor, damp circumstances with inadequate heating and fearful of how they can survive a difficult winter receive a statement to the effect that their fuel allowance has been increased by €5.
Is the Taoiseach happy with a situation whereby outrageous, disproportionate price increases are permitted in order to increase profits in the energy sector to attract in new entrants in order to provide competition to keep prices down? That is the argument. In order to keep prices down we must let them rip up to 34% in gas, and in electricity to 19.4% for domestic use, 19.6% for small and medium enterprises and 21% for large companies. That is the official position. The argument made by the ESB and the gas company is that we must let profits rip to attract new entrants.
This country has gone mad on ideological competition. The authority set up to police it does not do its job. It is great at lecturing and hectoring and so on but when did it intervene to have a major hit against any of the collusive and other activity of significant players in this marketplace? This is becoming an intolerably high-priced environment and older people and social welfare recipients are the ones at the bottom of the ladder who will suffer most.
Deputy Rabbitte quoted parts of the Minister's statement. The Minister, however, went on to point out that he was increasing the number of units to assist the over 600,000 people who would be severely affected by the large increases in energy costs. These increases, mainly due to the price increase of gas from Russia, have been internationally imposed. Ireland imports 86% of its gas indirectly from Russia which contributes to a large part to our energy generation. The Minister increased the number of units that 630,000 people get free from 1,800 to 2,004. This is the calculation that will ensure they will be fully protected from the recent increases.
Deputy Rabbitte is not. It is not my role to defend the ESB or Bord Gáis Éireann, but the Deputy should be fair and at least give the factual position. BGE made a profit of €90 million last year, an increase in its profit from the previous year despite growing sales of €100 million. The CER allows BGE to make a margin of 1.3% on its gas sales, a very small percentage.
Up to 86% of our gas comes from the UK. If BGE does not receive a price increase to reflect the increase in the UK wholesale price of gas, it would have a €50 million negative impact on BGE's profit next year, over half of its annual profits from this year.
BGE has a debt of €1.2 billion which is the subject of strict price covenants. Breaching those covenants or downgrading BGE's credit rating would lead to large penalties and difficulties for the company. We must be honest in this argument.
On the Taoiseach's argument about internationally imposed energy costs, since these increases were announced, energy prices have begun to fall. There is no capacity, as the regulator operates, for more than an annual review. Despite falling energy costs, these punitive increases of 34% will continue to apply. Meanwhile, there is an attempt to create an artificially competitive market in the electricity sector. Some small businesses are threatened with going out of operation as a result of the 19.6% increase that will apply to them.
What steps does the Government intend to take to address the issue raised by the Society of St. Vincent de Paul, among others? It pointed out that a disproportionate share of the budget available to it will go towards helping older people and those on social welfare payments of various kinds to pay gas and electricity bills. Following on the other increases in electricity and gas prices in recent times——
——I do not believe an individual with an income similar to that of the Taoiseach, or for that matter mine, can understand the impact the scale of a 34% increase will have on social welfare recipients and older people. The provision announced by the Minister for Social and Family Affairs is entirely inadequate in these circumstances. There ought to be a Government response——
In the past two budgets, the Minister for Finance gave exceptionally large increases to those on social welfare payments to bring them to a level discussed at the partnership talks. It is our position to continue this. For the over 630,000 people who are vulnerable and include the elderly, rather than wait until the budget we moved immediately to protect them on the calculation given by the regulator for gas and electricity increases.
Obviously, pension issues arise in the budget. Deputy Rabbitte is correct that the regulator makes a decision once a year. From the mid 1980s until 2002, there was only one increase in energy costs. The current system is that the regulator examines it over a year, based on the projections and accounts of BGE and the ESB. There are pluses and minuses to such a system. In the UK there were 13 price increases this year while we had one. In comparison to the UK, Npower increased prices by 30.8%, Scottish Power averaged 34.6% and Powergen, 24.4%.
In the meantime, we must face the reality that we are importing most of our gas. If we had it ourselves, it would be different.
The Government recognises that the Deloitte & Touche report which we recently published points to the need for an in-depth examination of electricity providers and of the dynamics of the electricity sector. We have stated that we recognise the fundamental role played by the ESB and that we will continue to protect that, as set out in the recently published Green Paper.
We are facing into another winter when patients will experience what is, all too often and too sadly, a hell in accident and emergency departments in hospitals throughout the country. People are queuing for admittance on trolleys and chairs. The reality is nothing other than a Third World situation for staff and patients alike. It is an intolerable situation.
Why is the Minister for Health and Children, rather than addressing this major crisis in our health system, proceeding to implement her madcap plan to privatise our hospital system? Why is she facilitating private health care developers with access to public land adjacent to public hospital facilities? How does the Taoiseach explain this proposition, which clearly did not appear in the Government's health strategy, the programme for Government or the manifestos of either the Fianna Fáil Party or the Progressive Democrats Party in advance of the last general election? The Taoiseach, the Minister and the Government have no mandate whatsoever for pressing ahead with this proposal.
This proposition is diverting public moneys through tax breaks and land access for private developers whose entire motivation is to view health care delivery as a means for profit. They view health care as a commodity to be traded as any other, bought and sold on the market. Is the Taoiseach aware that of those who seek access to the sites currently on offer, ten of which have been identified, there is a company called Triad bidding for at least six of them whose parent company in the United States had to pay $1.7 billion in fines to the United States justice department in settlement of a raft of criminal and civil charges brought against it by the United States Government? Are these the types of people and is this the type of system the Government wishes to impose on our acute hospital system?
I urge the Taoiseach to do something at this late stage, even in the mouth of a general election. Here he is in the last months of the Government, despite all the lessons in regard to Eircom and Aer Lingus——
The accusations Deputy Ó Caoláin made about a certain company have been denied by it.
We have had private medicine in this country since the second half of the 17th century. I understand it was introduced by Dean Jonathan Swift and it has developed ever since.
Deputy Ó Caoláin objects to the proposal that private beds available only for private use in public hospitals should be replaced by public beds for the use of public patients. I had expected most Members, particularly Deputy Ó Caoláin, to see the significant benefit in having all public beds in public hospitals available fully and exclusively for public use. I thought that was a progressive measure, but it is interesting to see that Sinn Féin is not in favour of that and wishes to continue with the position where there are public and private beds in public hospitals. That is the clear position.
The Minister for Health and Children will provide these private beds on the same campuses as public hospitals at half the cost of the conventional provision of new beds and in a far shorter timeframe. This means we will have a better mix of health care. It is a progressive approach and will accommodate more public patients.
I also take this opportunity to point out the significant increases and improvements we have made in recent months across a range of health care services. These include improvements in accident and emergency services and various palliative care areas, the provision of new beds in the new facilities being constructed, the employment of new staff to assist in alleviating the accident and emergency situation, improvements in home care packages and so on. The National Treatment Purchase Fund is of significant assistance and is an example of using the private sector to assist people on public waiting lists. Almost 50,000 patients have been treated in this way.
All these improvements are helping us move to where we want to go. Some difficulties remain but we are dealing with them and they can all ultimately be overcome. Accident and emergency services have been improved and other initiatives were introduced. I do not understand, therefore, why Deputy Ó Caoláin or anybody else would be opposed to the provision of private beds on the same campuses as public hospitals. All this will do is enhance the overall services by providing better facilities for patients in public hospitals and enhancing the mix of health care provision. Irish people have shown they wish to avail of private health insurance, which is their entitlement, and they are entitled to the necessary facilities.
The Taoiseach says we are moving to where he wants us to go in terms of the health service. On this issue as with so many others, the Taoiseach has no idea where he is going. We want to see an end to the piggybacking of private health care in the public health system. There is nothing wrong with the provision of private health care, either in respect of those who want it and those who want to provide it. The problem is the abuse by this Government of taxpayers' money. The public system, funded by the taxpayer, should not bail out private health care developers, and that is exactly what is happening.
Is that Fianna Fáil policy and is the Taoiseach proud of that? When he makes the point about Dean Swift, does he think the electorate and public are all Lilliputians? The reality is that the public is aware of what he is proposing. People throughout the length and breadth of the State are talking about this issue and are furious about it.
What we see is the total abandonment of the commitments made by the Taoiseach and his colleagues in government prior to the last general election and before that, where he clearly indicated the need and the commitment to provide 3,000 additional beds within the public health system. There have, however, only been identifiably 535 since 2001. Moreover, there is now a marked difference between that stated objective of the Government, particularly the Minister, and the view of the HSE chief executive officer, Professor Brendan Drumm, who says it is nonsense, that we do not need those beds. Where is the truth in all of this and where does the Government stand in regard to the utterances of Professor Drumm, who seems now to be more in charge of our health system than the Minister for Health and Children, who is supposed to be democratically accountable to the people? The Taoiseach, in turn——
The Deputy has asked the questions, and perhaps I will be able to answer them.
There are now 1,500 more beds in the system. The Deputy is incorrect to say that such sites are given away. They are not given away. They are either purchased or leased and provide good quality facilities. In many cases, the State can buy those services under the National Treatment Purchase Fund, from which 50,000 people have benefited.
Compared with September 2005, the average number of patients awaiting admission to accident and emergency departments is down by approximately 50%. The Deputy makes the point that we should be putting more resources into the public system. We have increased the amount allocated from approximately €3 billion to over €12 billion and increased staffing levels by 50%. We have a substantial capital programme of €500 million a year in the public hospital system. The Deputy will not acknowledge any of that, but he berates the fact that, through tax incentives, we are helping some private operations in the country to provide a service for the thousands who want it. There is absolutely nothing wrong with that. All the figures and activities regarding inpatients, outpatients, home care packages and palliative care packages show that we are increasing numbers and capacity all the time for public patients.
The Deputy's arguments do not hold up. His basic point is that he objects to the current private beds being removed from public hospitals.
The Deputy's point seems to be that those who use VHI and BUPA and those public patients in neither but who benefit from the National Treatment Purchase Fund should not be entitled to do so. That is a wrong analysis. We may still have some problems to deal with, but that analysis is a nonsense.
That concludes Leaders' Questions. The Chair draws the attention of the House to the fact that 21 minutes are provided for the three leaders' questions, but we have taken more than twice that time this morning. I appeal to leaders to try to stay within the allotted time, otherwise change the relevant Standing Order.