Dáil debates

Tuesday, 5 December 2006

Other Questions

Nursing Home Inspections.

3:00 pm

Photo of Olivia MitchellOlivia Mitchell (Dublin South, Fine Gael)
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Question 50: To ask the Minister for Health and Children if she is satisfied that the Health Service Executive has a robust, uniform, national inspection system in place for nursing homes as it has claimed; the steps she has taken to satisfy the Houses of the Oireachtas on this matter; and if she will make a statement on the matter. [41408/06]

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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The Health Service Executive is continuing to strengthen the nursing home inspection process. Guidelines have been issued to nursing homes inspection teams nationally and the structure of inspection teams is being strengthened. In particular, the Health Service Executive is in the process of developing dedicated nursing home inspection teams which are already in place in some areas. All the mandatory six-monthly inspections will be unannounced. Follow-up inspections may be announced or unannounced. A standardised registration certificate will be used. A significant training programme for all inspection team members is scheduled to commence in January.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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When Mr. Aidan Brown addressed the Oireachtas Joint Committee on Health and Children, he said that since the beginning of the year all inspections teams comprised a nurse, a doctor and an environmental health officer. When I informed him that I was aware of at least one case in which an inspection team had an inspector but no doctor or nurse, he suddenly said that still happens in some parts of the country. In the space of a sentence it went from never happening to happening. Is €2 million enough to establish HIQA and the social services inspectorate or will we be left with piecemeal inspection of nursing homes? Apart from the fact that no legislation has been enacted in the last two years to protect health service patients, at the same committee a HSE official said the Minister had not signed off on the complaints procedure of the HSE as expected under Part 9 of the Health Act 2004 under which the HSE was established. Is that correct? Although an impression was given that it had been done, when we forced the issue, it appeared the Minister had not signed off on the complaints procedure provided for in Part 9.

Has the Minister met any of the senior HSE officials involved in the inspection of Leas Cross in recent years? Have the Minister and Ministers of State learned anything from this experience? This is important. They take information at face value without getting down into the trenches and finding out what is going on. When I accused the Minister and senior HSE officials of colluding in the continued barbarity at Leas Cross, there was not one denial. That is telling.

Is the Minister of State aware that senior HSE officials ask health professionals not to make their complaints about quality of care in writing to them but to write to local HSE officials? This is important. Does the Minister of State approve of this new form of accountability in the HSE, whereby he will try to scapegoat officials lower down the chain of command? Health professionals are now being told not to write to senior HSE officials in order that they might know what is happening in the HSE. That is despicable. Having heard this, I do not believe the Minister, the Ministers of State, the Government or senior officials in the HSE have learned anything from what happened at Leas Cross.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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There is nothing like being consistent. Last time the Deputy said we would not publish the Leas Cross report.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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What am I saying today?

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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Since we proved the Deputy wrong, this side of the House will not be too upset about his recent comments.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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The Department was forced to publish the Leas Cross report. The Minister of State should be honest.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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The Deputy probably thinks he made us do it. Another feather in his cap.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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We will not take credit for everything.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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The procedures have been signed off and will come into effect from 1 January.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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When were they signed off?

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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It is obvious from the Leas Cross report that the inspection system in place did not work as well as it should have and failed the patients at Leas Cross. On foot of this, the HSE sought a report which Professor O'Neill produced. Even before the report was published, the HSE had embarked on changing the way in which inspection teams worked. It is intended to establish dedicated teams, provide proper training programmes for them and have a standardised approach nationally. The inspection reports will be published. This process only began in September. It is an important step towards ensuring proper standards of care in homes. It will benefit patients and families to know homes are inspected regularly and that they are providing proper care. The health Bill will be published next week. Adequate resources have been provided to establish the HIQA. This is necessary in providing proper care for older people, for which we have made adequate provision.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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Does the Minister of State mean it is only the Government's intention to establish inspection teams? He did not answer any of my questions.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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Following the "Prime Time Investigates" investigation of Leas Cross——

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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That was a year and a half ago.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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——-it became obvious to everyone, including the HSE, that the inspection system was inadequate and had failed miserably at Leas Cross. The HSE put together a working group and made a number of changes.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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We knew that five years ago.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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It is trying to create dedicated inspection teams, some of which are in place. There will be a standardised approach to the way in which homes are inspected everywhere. Therefore, the same standard will apply in counties Dublin, Galway and Kerry and everywhere else. We are bringing it forward.

On the health Bill, we have drawn up a draft set of standards. The Bill will be published next week and we hope, with the co-operation of the Opposition, to pass it early next year.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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What about the HSE officials' not wanting to receive letters from health professionals? Does the Minister of State know what is happening on the ground?

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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I would be surprised if that were the case. If the Deputy has evidence to support what he says, I would be happy to follow up the matter.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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It is the Minister of State's job to find out what is happening. He should not be so naive.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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Does the Minister of State accept that what he is experiencing is the direct result of misguided policy? Professor O'Neill made it clear that over-reliance on the private sector had made the task of protecting residents more difficult because it was harder to maintain quality in private nursing homes than in community nursing homes. Those were his words. Is the Minister of State aware of the great shortage of public health doctors? There are many vacancies in the HSE because of the changes that occurred. We do not have dedicated and trained teams carrying out these inspections. Can the Minister of State comment on these shortcomings? He could also comment on those with disabilities in institutional care. What checks verify that inspections are carried out in an acceptable fashion? Is the Minister of State aware of criticisms regarding the infringement of residents' rights? Residents are sometimes asked quite personal questions in public spaces in nursing homes when inspections are carried out.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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Professor O'Neill spoke of empowerment at a recent committee meeting. Will the Minister of State encourage setting up residents' committees? Professor O'Neill spoke favourably of it. What percentage of inspections include a medical examination? There was some disagreement between HSE officials on the number of medical inspections carried out.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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MRSA and Families highlighted what it regards as the inadequate response to the prevention, detection and treatment of MRSA in care institutions. The substantive question refers to a robust, uniform and national inspection system. Is it intended that the same visitation will address this matter in nursing homes or will it be dealt with independently? What steps have been taken to ensure a universal standard of hygiene in all of these institutions so that we can eradicate the scourge of MRSA as far as is humanly possible?

James Breen (Clare, Independent)
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Are hospitals tipped off in advance of inspections? The Minister of State, Deputy Tim O'Malley, should be concerned about the psychiatric hospital in Limerick. A few months ago, before the inspection took place, if one stood still one was cleaned. Cleaners arrived at 6 o'clock that morning but have not been seen outside regular hours since then. This suggests staff were tipped off about the inspection. Is that true and is that happening? What will the Minister of State do to stamp it out? Nursing homes and hospitals should not be tipped off. A second Limerick hospital was also tipped off in advance.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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Hospitals are not tipped off.

Paudge Connolly (Cavan-Monaghan, Independent)
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On a point of order, I worked in the psychiatric service for 29 years. Every hospital is informed of the date of inspection one month in advance. That was the situation while I worked there.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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I can clarify it. Deputy Connolly is referring to psychiatric hospitals. That is a different matter. Very often, psychiatric hospitals are notified in advance.

Paudge Connolly (Cavan-Monaghan, Independent)
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Can we take it the same procedure will apply to nursing homes?

Séamus Pattison (Carlow-Kilkenny, Labour)
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The Minister of State should proceed with his reply to the previous Deputy.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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That is a matter for the Mental Health Commission. Regarding the misguided policy to which Deputy McManus referred, it was a Labour Minister who introduced the subvention scheme that encouraged people to use private nursing homes.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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It was a good idea.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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Private nursing homes play an important role in the provision of care.

Photo of Liz McManusLiz McManus (Wicklow, Labour)
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In the right place.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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We are organising training for dedicated teams in January. That has not happened until now and will make the teams much better equipped. There will be a standardised approach across the country.

It was the policy of inspection teams to work with nursing homes if difficulties arose. In most cases that worked but in the case of Leas Cross it did not. We have learned from mistakes made, which is why we are introducing a new health Bill and new standards. Deputy Gormley referred to residents' committees, which is already the practice.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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Is it the case in every nursing home?

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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The hygiene audit will be extended to the community sector.