Dáil debates

Thursday, 25 January 2007

Health Bill 2006: Second Stage (Resumed)


Question again proposed: "That the Bill be now read a Second Time."

John Dennehy (Cork South Central, Fianna Fail)
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While making my contribution last night I made a few general points on the Bill, one being that health expenditure has increased fourfold over the past nine years. There is also a need to resolve the problems of vested interests in all disciplines, particularly in the orthodontic area. I indicated that the handling of the Neary inquiry by the peer group will probably be the catalyst for major changes in self-regulation by all professionals and that PPARS had failed to fully deliver primarily because of the existence of over 1,000 separate local agreements or arrangements relating to personnel etc.

These spell out a significant problem for any proposed reforms within the health service. Many other factors must change and are changing, including the behaviour towards consultants in the sector. The days of the God-like figure lording it over everyone, including junior staff, administrators and, most significantly, patients or clients, can no longer be tolerated. In the majority of cases, it is now possible to have a meaningful discussion with any consultant about one's case or that of a relative receiving attention.

Changes had to come about in that respect and, thankfully, that has happened. It should be said in passing that consultants will not be taken advantage of despite all these changes. They have an excellent trade union in place, although they are very shy about describing it as such. They have an excellent negotiating body and the outcome will be all right.

I have mentioned consultants several times during my contribution, primarily because I believe they are key players in the provision of services. It is important that they take part in these changes. Professor Drumm would tell us he is the holder of a common contract himself and knows the issues involved. Others at the coal face, be they nurses, general practitioners or pharmacists, will also need to be fully involved in any proposed changes. I know the head of the Labour Court made an appeal to people to be frank and agree to changes and the need for change.

I hope many of the issues, be they with the IMO, the consultants' body, or pharmacists, can be sorted out reasonably quickly. Some of the suggested agreements on the common contract, the medical card system, etc, have been going on for four or five years and this should not be happening in trade union matters. There should be a mechanism for dealing with it more quickly.

A rigorous inspection system for nursing homes will be introduced under the Bill and cover many types of residential care centres, forcing them to undergo a standard registration process. It will also establish parameters for their operation and registration details will be made public, an important point to ensure full transparency. We were reluctant to criticise some nursing homes on the basis that they were doing the job of the State in providing beds for elderly people. Such people should be cared for by the State where necessary.

Offences under the Bill will involve fines of up to €5,000 or imprisonment of up to 12 months and stronger sentences can be meted out. That is the extreme endgame and I hope there will be voluntary compliance with codes. As there will be a proper inspection regime in place, this will happen. People may forget that it was only in 1993 that the Health (Nursing Homes) Act came into effect and up until then there was no subsidy for anybody. People were in very distressing situations, particularly where only one person was able to contribute. In other cases, four or five family members could share the cost of a home.

Since the Act came into effect, much has happened and we have rightly become more critical of wrongdoings. A number of people who contributed to the debate last night indicated that the vast majority of people running nursing homes are doing so in a very capable and acceptable fashion. They are running a business and must make a profit to keep going, but they are doing a good job at the same time.

I have been involved with health boards for more than 20 years and one in particular — the former Southern Health Board. I have always been concerned about catch-all phrases such as care of the elderly which are used to cover a multitude of things. It is a lazy expression. We must break it down because it is handily used to lump a large proportion of the population into one group. We are afraid to get too personal about the people needing services for Alzheimer's disease or other geriatric conditions. A range of issues involve people who have exceeded 65 or 70 years of age or whatever is the target age with which we like to brand people. It is handy for administration to use a catch-all phrase.

Every Government of the past 30 years failed on this issue and I do not mind saying this. I stated here previously that as a long-serving Government Member, I felt guilty when a survey I requested from the Southern Health Board in 2001 indicated more than 200 extra beds were needed in the Cork area alone to care for the elderly. Despite all the arguing I did, people were let down and we must redress this failure.

A suggestion was made three or four years ago that four new homes would be provided in or near the city under public private partnership. It ran into difficulty with EUROSTAT, the control mechanism of spending by states. The Cork College of Music also ran into trouble with it. I believe it has now been resurrected. One site, located near County Hall, was bought from nuns and I expected work to begin four or five years ago. We need these centres and the State must be proactive in providing them.

Recent debate on this sector centred on the nursing home repayment scheme and the repayment of charges which the Supreme Court found to be illegally levied on elderly people. The debate should go well beyond this issue. Our primary objective should be to identify the form and level of care an elderly person should expect to receive when he or she requires it. The establishment of the information quality authority and the office of chief inspector should assist in this process. Approximately €105 million or €135 million was spent on nursing homes in 2005. It is a tiny element of the total expenditure of €23 billion. It is not a fair share of funding for elderly people. The rest is primarily spent on acute care.

We must always do more for older people in society, whether it is essential repairs to houses, home help packages or benefits for people living alone. The Government must continue to lead and show that older people remain a priority. Older people's groups have become more vocal and demanding and rightly so. They have become more organised and I welcome that; they should demand their fair share. Other groups have trade unions working for them and can negotiate. Members of both Houses of the Oireachtas represent these people and it is part of our job to continue to lobby for them whether it is within our parties, in the Chambers or elsewhere.

The new Health Information Quality Authority will be extremely important. People may take for granted the setting and monitoring of standards in the delivery of health and personal social services and assume a standard exists across the board. It does not. In two hours time at a meeting of the Committee of Public Accounts I will point out to Professor Drumm that when PPARS was first tried out, more than 1,000 agreements were in place throughout the eight health boards. This was a ludicrous situation. We need to have a standard throughout the country. Whether one lives in Cork, Dublin or Galway the standard applied should be equal. We must ensure this happens and it is hoped this is the start of that reform.

I mentioned the public orthodontic service and I make no excuse for returning to the matter. The sub-committee on orthodontics of the Joint Committee on Health and Children spent six months preparing a report on which we must act speedily. It is another area where vested interests have taken control.

Everyone involved in the supply of services must co-operate. We have turf wars in Dublin over the children's hospital. I am not qualified to comment on the correctness of the chosen location. The only hospital I have had involvement with is Crumlin children's hospital. We cannot afford to have turf wars on issues such as this. The parents of sick children are quite correct to state they do not care where the hospital is located and that it is urgently required.

It is not all bad news. A state-of-the-art maternity hospital was opened recently at Cork University Hospital. Progress can also be seen in the three other new units of various disciplines at the hospital. We must continue this throughout the country. I am concerned about rumours that cancer care services will not roll out as quickly as possible and I will also raise this with Professor Drumm.

Each week I see the site works at the South Infirmary-Victoria Hospital for the provision of BreastCheck. I am a member of the South Infirmary board. The information I received last week is that it is on cue. We must continue to co-operate to supply the services. Cork requires specialist paediatric equipment and diabetic services for young children, particularly if those children suffer from more than diabetes. The reform of the health package will help to deal with these issues.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I am pleased the Dáil has given time to debate this important Bill. However, I am disappointed the debate will end at 2 p.m. today. This is an occasion to reiterate what happened in nursing homes throughout the country. I will read from a report on an investigation into a nursing home in Cork. When I am finished I will explain why it is different from Leas Cross and Bedford House.

A number of complaints were made about a nursing home in Cork city. At the time, the registered owner was a medical doctor. The home changed ownership in January 2006. I want to stress that since then it has not been in the ownership of the former proprietor. Today, I asked the health board for a report on the home under its new ownership, which will be provided as soon as possible. Everything I state involves a nursing home operated by a Cork doctor between 1994 and January 2006.

Complaints were made about this nursing home, as a result of which a special inquiry board was established by the HSE. This is different from the nursing homes I spoke about previously as it is the result of an inquiry by the HSE into what happened in 2003 and 2004. Many people might say it is a long time ago but it is in the lifetime of this Dáil. It came to light after the Government made the promise in 2002 that it would introduce the legislation which is now before the House.

The delay in introducing this Bill is exacerbated by the knowledge the HSE had of this nursing home, the report on the nursing home and the fact it was sent to the Minister for Health and Children in September 2004, which happens to be the month the Minister for Health and Children, Deputy Harney, took up her present position.

I will read quickly from the report and make it available to the press afterwards:

The purpose of the investigation is to carry out an investigation under the Health (Nursing Homes) Act 1990 and the Nursing Home Regulations made thereunder, into the operation of this Nursing Home; to review the existing standards, policy and procedures in the home and to recommend any action or changes in existing arrangements necessary.

Membership of the investigation team comprised Mr. Conal Devine, chairperson; Dr. Catherine Murphy, senior area medical officer; Ms Regina Eviston, matron at Dunmanway Community Hospital; Ms Mary Falvey, principal environmental health officer and Ms Deborah Harrington, section officer, Southern Health Board. These are all suitably and highly qualified people. The proof they said they would apply to an allegation would be similar to that which would apply in a civil case. In other words, they would need a standard of proof to prove whether an allegation was true.

They conducted a number of interviews from 4 May 2004 to 29 July 2004. The report stated that the complaints officer of the former Southern Health Board, Ms Bridget O'Brien, investigated three separate complaints relating to the care of residents in this home. Two of these complaints related to a period in 2003, while the other complaint went back to December 2002. I am taking salient points from the report.

What were the findings of the environmental health officer, Ms Mary Falvey? In respect of the kitchen facilities she found:

The main kitchen was maintained in a clean condition; however, a large amount of boxes of washing detergent were stored in the kitchen area. These should be stored in a cleaning chemicals store. Delivery check records were available as were cooking and refrigerator temperature checks. The cooked food refrigerator was not maintaining food at 5° Centigrade. A variety of temperatures ranging from 7° Centigrade to 13.5° Centigrade were noted during the inspections.

The report stated that the cooking of lunch immediately prior to service is recommended. It also recommended the provision of a catering fan. It stated: "annual calibration of thermometer as temperature readings at 4 p.m. on records did not reflect readings noted by myself" and, a very important recommendation, that "the cook employed at weekends should receive food hygiene training." In respect of the service kitchen, the report said:

The wash hand basin was inaccessible due to the use of a wooden board, which covered the basin area. Both milk dispensers were dirty in the area from which milk was dispensed, and in my opinion had not been recently cleaned. Coagulated milk was visible on this area. The base of one of the dispensers was rusted. The microwave was not properly cleaned and the interior top surface was dirty. Cleaning records showed these units, microwave and milk dispensers, had been cleaned on a daily basis. The evidence indicated inadequate cleaning.

The report recommended the supervision of staff, that the cover on the wash hand basin be replaced and that the proprietor carry out and make adequate arrangements for the prevention of infection, infestation, toxic conditions or spread of infection.

In respect of the dining area for more dependent patients, the report said that "the timber surfaces supporting the formica tops were dirty with food debris as was the wall surface adjacent to the tables". It also said: "in several showers a white powdery deposit was noted on the surface of the tiles." In room 13, the report stated:

A gap between the door of the toilet and the end wall was visible. A lengthy crack was visible between tiles on the end wall. A large hole was visible in the ceiling.

In respect of the laundry, the report stated:

There were large holes with daylight clearly visible at the base of the external wall where holes had been provided to facilitate venting from drying equipment. The open end of ducting and the gaps around the vent ducting must be rodent-proofed to prevent access by rodents. Accumulation of piping and debris in corners of the laundry could provide harbourage for rodents. A small room in the centre of the laundry housing a water cylinder contained cardboard boxes. This area should be cleared of non-essential items as such undisturbed areas can provide harbourage.

It also stated: "openings in walls and ceiling for pipe work should be closed to prevent rodents' access." In respect of hand washing facilities, the report stated:

The patient w.c. facilities adjacent to their dining room were not supplied with warm water for hand washing. The staff toilet was provided with a communal towel. This is unacceptable and must be replaced with a single use facility e.g. paper towels.

The report stated that the waste storage area should be cleaned and that the ground area around the waste storage area was not kept clean. It recommended that the proprietor and the person in charge of the nursing home shall take adequate precautions against the risk of fire, including the provision of adequate means of escape, and make adequate arrangements to secure by means of fire drill and practices that the staff, and so far as is practicable, dependent persons in the nursing home, know the procedure to be followed in the case of fire. The report went on to state:

An exit from the office to the car park area, which had a fire exit sign overhead, was locked on the 16 June 2004. Its key was not available. Loose mats, potential tripping hazards, were noted on the floor of the fire escape near the entrances from the corridors.

Large items i.e. a bath, a commode and a mattress, were stored along the fire escape.

The nursing practice findings make very serious reading. The report stated that there was an insufficient number of nursing staff on duty and that waterlow pressure sore risk assessment carried out on all patients demonstrated that 22 of the 29 patients were at risk of developing pressure sores. It stated that "of those 22 patients, 9 are at high risk and 3 are at very high risk of developing pressure sores." The report goes on to identify issues relating to high, medium and low dependency. It contains a very important comment which I emphasise. The Investigation Team noted that the SHB [the former Southern Health Board] Complaints Officer, Brigid O'Brien, stated in her report of 30/12/2003 to Dr. Claire O'Sullivan, SAMO that "in my view ill old people should not be referred to this nursing home."

The report stated that adequate accommodation must be provided and that the dividing curtains in twin rooms are too small. In respect of the unfortunate patient in room 2, the report stated:

Room no. 2, resident's mattress is on the floor. This practice, which was advised upon at last inspection (02/03/04) is still not appropriate. At the announced inspection the mattress was on the bed and during the unannounced inspection it was found to be on the floor again.

The report went on to state that railings are required in the grounds to prevent injury and window restrictors are required on all first and second floor windows to prevent falls. It stated that all radiators throughout the nursing home should have radiator covers. It stated that the place should be made secure from interference by unauthorised persons, children or scavenging animals and that health care risk waste must be kept separate from non-risk waste. It stated that clinical waste was not stored or disposed of in accordance with Department of Health and Children policies.

Inadequate daily recording of patient's activities of daily living and conditions were found. The report stated that narrative notes should be written frequently enough to give a picture of the patient's condition and care to anyone reading them. There was no evidence of this in the examination of specific case notes. In respect of records of any accident or fall involving a dependent person, the report states that records of known incidents were not recorded.

It stated that recording of controlled drugs are in breach of An Bord Altranais guidance and that policy and procedures should be in place for checking a stock balance at each transaction. It stated that at changeover of shifts, a nurse from each shift should complete the count of these scheduled drugs. Drugs had not been checked for four days on inspection.

Many of the findings in the medical officer's report repeat what was stated earlier, but I will read some I have highlighted. The report stated that on the day of the unannounced inspection the mattress was placed on the floor in room 2 in the west wing, while on the day of the unannounced inspection, the mattress was placed on the floor. It stated: "This situation is inappropriate", which is a rather weak comment. It stated that the light in the en-suite room should be repaired, that toilet seat covers should be replaced in rooms 14, 16 and 17 in the west wing, that gaps and holes in walls should be filled in and that the cloth towel in the staff toilet in the west wing should be replaced with paper towels and so on.

The report goes on to state that the bound register should have all details recorded as per regulations, including the date of discharge and death, and that there should be one entry per page. It states that all drugs administered by nursing staff should be prescribed and written in drug charts.

What were the findings in respect of complaints made regarding individual residents in the nursing home? Have I much time left?

Séamus Pattison (Carlow-Kilkenny, Labour)
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Deputy O'Dowd has eight minutes left. It is not quite in order for a contribution to a debate to consist completely of quotations. Perhaps the Deputy will lay the document formally before the House.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I will lay the document before the House. I appreciate the point made by the Leas-Cheann Comhairle.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Deputy O'Dowd may make selective quotations.

11:00 am

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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In respect of a nursing home, the report stated that a complaint that a patient's clothes which were missing were worn by other residents was upheld. It stated that on 3 December, a particular patient was not walking or talking at all and that on 9 December his condition had deteriorated and his relatives thought he was dying. On ringing later that day, the family was informed that this patient had been transferred to hospital. The patient had been transferred without the family's knowledge. The report stated that this patient had pressure sores that were not dressed, had bruising on the shin, was totally dehydrated, had a possible fractured hip and a chest infection and was unable to speak. All these complaints were upheld. The report stated that there was one recorded fall on the admission chart but the complainant had witnessed at least two. This poor person was sent by ambulance to hospital wearing only his pyjamas. No bag was sent with him. There were other significant breaches. There was a delay by staff in changing incontinence wear. Significant sores were evident on the heels of the patient immediately following her discharge. The finding of the report was clear, namely, that no formal arrangements were in place for a matron or nurse in charge during the first eight months of 2003. This home was being run by a doctor but he had no matron in charge. In effect, nobody was running the place. This information was given to the Department in September 2004. It is now January 2007 and there is still no legislation to protect those people. It was stated that the exceptionally low level of nursing staff should be taken into account. The report continued in that vein. I could not get this document from the HSE because somebody appealed it to the Information Commissioner, as was their right. I received a copy yesterday by fax. It is important to note both how long it took to get the report and for the Government to act.

Reference is made to an absconscion. This term relates to a person leaving a nursing home through wandering due to Alzheimer's disease or other dementia or whether he or she just left. The details are in the report. The investigation team noted in respect of the absconscion that the medical officer-proprietor provided an account of it in the nursing notes despite the fact that he was not present in the nursing home immediately prior to or in the course of the absconscion. The investigating team found this to be highly irregular, not in accordance with good practice but consistent with the poor recording of adverse incidents in respect of each of the incidences examined by the team.

The reality is the Government knew how bad the nursing home was, as it was told by the HSE. In 2003 a health board official stated no sick person should be sent there but people continued to be sent there and the Minister did nothing about it. That is where all of this comes together today. The Minister refused to act on the clear recommendations of this report. I will provide this document by Mr. Conal Devine to the House. The investigation team strongly recommended that the current nursing home regulations would be revised in their entirety. It went through them and made detailed recommendations on what should happen to bring about change. That was in September 2004. When the Minister, Deputy Harney, went into office she made a strong statement about care of the elderly. This report was in her Department and may have been on her desk but she did not act on it and has not acted on it yet.

An inquiry needs to be made into this nursing home, in addition to Leas Cross, Bedford House which was run by a doctor also, Rathfarnham nursing home, Conifer House, Devey Healthcare and Castlelodge. All these nursing homes have given the HSE grave cause for concern. We need an investigation but most of all we need the public to make a judgment on the Minister of State, Deputy Seán Power, and his leadership on this issue.

I received an e-mail from the HSE in Cork today regarding the registration details of St. Albert's nursing home. The date of first registration was 1 September 1994. The registered proprietor was Dr. Martin Moloney. The address of the nursing home was St. Albert's Nursing Home, Blairs Hill, Sunday's Well, Cork. This nursing home was subsequently re-registered in 1997, 2000 and 2003. I stress that the ownership of this nursing home changed on 1 January 2006 and Dr. Moloney no longer has any involvement in it. Nothing I have said pertains in any way to the current owners of that nursing home.

I have raised this issue time and again in the House. The Bill will not change anything unless it includes a bill outlining rights of residents. Many countries have such a bill of rights for care of the elderly in nursing homes. Rights are identified and included in legislation which can be protected and defended. The Government allows people to be treated in an appalling way. In this case the Government cannot escape the fact that it was told what was happening and that the information was on the Minister's desk. In spite of this, the Minister did not act to protect those people, nor did the doctor who ran the home. It is an appalling shame that Bedford House and St. Albert's were run by consultant doctors. They betrayed a basic and fundamental trust. One assumes it is good to have a doctor running a nursing home, and that is true in many cases, but in these two cases it was not.

I only received the report yesterday. Will the Minister of State indicate if the documents were sent to the Director of Public Prosecutions or the Medical Council? If they have not been, I urge him to do so now. I also urge him to send all the records in the possession of the HSE pertaining to the nursing homes to which I referred to the Garda for investigation. It is essential we get accountability, in a political sense from the Minister, but also from the administrators and the medical profession. What happened was shameful and we must ensure it never happens again.

I do not believe the Minister of State, Deputy Seán Power, has the capacity, determination or commitment to change things. The Government merely offers window dressing. It did nothing for many years in spite of knowing how bad was the situation. It is unforgivable that these people were allowed to be treated so appallingly, disgracefully and shamefully at a time when so much money is available to provide care and attention for them. The Government stands indicted once again in the court of public opinion. In the coming general election we will make it clear where the Government failed to provide leadership in health care. It ignored the facts and let old people die in appalling, shameful and disgraceful circumstances.

Photo of   John Curran John Curran (Dublin Mid West, Fianna Fail)
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I wish to share time with Deputy Wilkinson.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Is that agreed? Agreed.

Photo of   John Curran John Curran (Dublin Mid West, Fianna Fail)
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Before I look at the specifics of the Bill I wish to make some general comments. It is unusual for me to speak on health-related issues yet like many colleagues in the House we have much experience dealing with health services as public representatives but also as individuals and family members.

At the weekend I considered the health issues that arise. I regret the debate is frequently predictable. We on this side of the House comment on the new services, additional expenditure and what is being done. On the opposite side of the House it is easy to highlight cases of neglect and issues of which we could not be proud that should not have happened but do happen. Those engaged in the health service, GPs, nurses and consultants, add to the debate from their own perspective. Much of the time when we debate health issues we are not patient orientated. The patient should be the centre of our attention and we should debate the issues around that but frequently that does not happen when we come from our own backgrounds and vested interests.

I welcome the opportunity to speak on the Bill. Frequently, backbench Members on the Government side are accused of being armed with a speech prepared by the Department or the party but that is not the case with me. I knew generally what the Bill contained but I read it on Sunday afternoon when I was at home on my own. Later I went out for a pint with three friends. Initially, the conversation focused on what I had been doing for the afternoon as my friends could not reach me. I said I was at home reading a Bill. They could not believe it. They asked me what it was about. They thought it was a reflection of how sad my life is that I was reading a Bill on a Sunday afternoon. Arsenal and Manchester United were playing and they could not believe I was not watching the match. I said I could have watched the match, read John Drennan in the Sunday Independent or studied McKinsey but I read the Health Bill. They were intrigued and asked me what the Bill was about as a test of how much I remembered of what I had read. I explained it to them. I omitted to say that my three married friends and I out on a Sunday afternoon were watching the time because we had to be home at various times, depending on the curfew given by our wives. One of the guys said his wife was visiting her uncle in a nursing home. Having looked through the main contents and provisions of the Bill he asked if the regulations being introduced now are not in existence. The public perception is that for private and HSE nursing homes those regulations are in place. They could not believe the provisions of the Bill to which we refer. The Bill is a fine one.

It is a pity the previous speaker has left the House because he made the point that this legislation had been promised for a period. He is probably right on that and I do not disagree. Let us be honest, passing the legislation is not as important as its enactment. Frequently legislation is passed——

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Various sections——

Photo of   John Curran John Curran (Dublin Mid West, Fianna Fail)
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——but the various sections are not enacted in a timely fashion. With specific reference to this Bill it is worth noting the comments of the Minister for Health and Children yesterday when she assured the House the preparatory work has been carried out by the interim HIQA, so that as soon as the legislation is enacted, the authority will be ready to use its powers. That is important and it should be put in context. It is too easy to stand back and say the Bill is late and that nothing is being done. It is exactly the opposite in this case and that point should have been acknowledged by the previous speaker.

I welcome the Bill which provides for the establishment of the Health Information and Quality Authority and the office of the chief inspector of social services. Section 7 sets out of the functions of the authority. It provides for setting and monitoring standards on safety and quality in health and personal social services provided by the HSE or service providers and advising the Minister and the HSE on the level of compliance with those standards, carrying out reviews to ensure the best outcomes for resources are available to the HSE, carrying out assessments of health technologies, evaluating information on health and personal social services and so on.

It is important to realise this is not just an inspection regime, that standards will be set and there will be criteria for measuring performance. The families and relatives of those in nursing homes, private or otherwise, need to know that their relatives and friends are adequately and properly taken care of. We have seen examples in the past where that has not been the case. Our public service provider, RTE, has adequately shown the case. For many of us who did not have a day to day experience we were shocked with what we found. This specific legislation goes a long way to addressing the concerns raised. Inspection on its own is simply not enough; setting standards is the key. In that regard I refer to the point the Minister made yesterday that work is well under way in advance of the legislation being passed.

That means that shortly after the passing of the Bill the independent inspectorate will be operational for all nursing homes for older people, public and private, as well as for centres for people with disabilities and children. The Bill provides for registration and inspection and tough powers for the new authority which will allow for urgent closure in cases of non-compliance. The public must have absolute confidence in these facilities be they public or private. That the ultimate sanction can be immediate closure helps compliance.

I wish to mention a particular aspect because it arose recently at the Joint Committee on Health and Children. One of the functions of the new authority is to evaluate the clinical and cost effectiveness of health technologies, including drugs, and provide advice arising out of the evaluation to the Minister and the executive. While it may appear to be a small item in the legislation it is timely and important. Recently we have had a debate on the provision of generic drugs where those who were involved in dealing with epilepsy, in particular, were concerned about the effectiveness of generic drugs versus the traditional branded drug, particularly where it had been prescribed for an extended period. In that regard it is important that the Minister has independent advice to evaluate that type of decision making because the implications are profound for those who may use it. There are similar type aspects included in the Bill that need to be acknowledged.

One of the Minister's final comments in her contribution yesterday was that she intends to introduce an amendment to provide protection for what is commonly called whistleblowing, that is, those engaged in the health service professions who come forward with information.

While slightly outside the remit, I wish to make a comment. Much debate has taken place recently on the National Children's Hospital. This time two years ago I spent every day in Our Lady's Hospital in Crumlin. Since then I have met and spoken with a number of the consultants. Much debate has taken place on the location, the Mater Hospital site, transport problems and so on. Others have argued that it should be co-located, one on the northside and one on the southside. From my personal experience a single location is paramount. I saw my daughter in Our Lady's Hospital in a critical condition where an effort was made to transfer her to Beaumont Hospital for particular tests and it simply was not possible. The illnesses that children suffer cannot be clearly categorised where one is suitable to hospital A or hospital B. There is a cross-over of services and if there are two hospitals the services are duplicated.

For parents of very sick children or children who have long-term illnesses, location comes second to medical expertise and professionalism. We want the best outcomes, the best technologies and the best staff. I am not convinced that co-location can provide the best outcome. That is not just my experience in regard to my daughter. If one goes to Crumlin hospital any day and looks at patients who would be transferred to another location for a test or procedure, it is clear that a single location with world-class services is what is required. The debate should refocus on the provision of services within that hospital rather than where the hospital is located. Like any politician I would like it located in my constituency. From a medical point of view for a national facility I do not support co-location. We duplicate services and we do not have the world-class service in a single site that parents of sick children want. I defy any Member who is dealing with a person with a serious illness, adult or child, to say their first concern is not where to get the best medical attention. Whether the person is from rural Ireland or wherever, travel is an inconvenience, but the best medical outcome is the paramount concern. Somewhere in the debate about the Mater Hospital and the National Children's Hospital as possible locations that aspect is missing.

I have deviated slightly from the Bill but having had personal experience I cannot stress strongly enough my view that a single site is what people want, need and deserve and the sooner we can deliver that the better.

Ollie Wilkinson (Waterford, Fianna Fail)
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I am delighted to have the opportunity to contribute to the debate on this important Bill. There is no doubt the disclosures during the past year or so on conditions pertaining in some nursing homes shocked us all. It is hard to believe that in this day and age when so much money is being spent on health care generally what happened in these places could happen to our most vulnerable elderly people. These people contributed enormously to the development of this country. In tough times they survived on little and it is only right that they should, in their final years, get the best care available. The disclosures were shocking. It is appalling to think about how these people, regardless of whether we knew them, were treated.

I welcome the publication of this Bill. I am glad that a great deal of work has already been done. That is only right. Even though in many cases it is too late, and we should acknowledge that, it is good that positive action is now being taken. However, as has been said already, legislation alone will not ensure that correct procedures are carried out. There is a great onus on the people who manage the various institutions to ensure that people are treated properly.

What can get lost in this debate is that there are many homes and places of care for elderly people which do a wonderful job. I am aware of many places in my constituency that are top of the range and give top quality service. The voluntary effort that is undertaken in some of these places should also be appreciated. That aspect can often be lost in the ongoing debate. Nevertheless, that standard of care should be available for everybody. There should be no exceptions. I am glad this legislation has been introduced and that work has commenced on putting the procedures in place to implement it.

I will briefly outline HIQA's functions. It is important to know what they are and to analyse them. The authority will undertake the setting and monitoring of standards on safety and quality in health and personal social services provided by the HSE or on behalf of the HSE and will advise the Minister and the HSE on the level of compliance with those standards. It will carry out reviews to ensure the best outcome for resources available to the HSE. That is of paramount importance; the value of such reviews cannot be overstated. The authority will also carry out assessments of health technologies. Of course, things change and technology is constantly improving health services. These assessments are necessary and they should apply to elderly people in care.

The authority will evaluate information on health and social services and the health and welfare of the population. It will advise the Minister and the HSE on deficiencies that are identified. That is being done following the shocking disclosures over the past year or so. The authority will undertake investigations as to the safety, quality and standard of services where the Minister believes there is serious risk to the health or welfare of a person receiving services.

These functions are very simple and one must wonder why they were not in place previously. The recent disclosures have ensured that everybody is now aware of the problems. It was hard to believe that such things were happening. I thank the Minister, Deputy Harney, and the Ministers of State, Deputy Seán Power and Deputy Tim O'Malley, for pushing this process forward. It cannot be pushed hard or fast enough.

Today we are discussing the care of elderly people but yesterday my constituency endured a shocking tragedy, the funeral of a young person. She met a tragic end after inhaling certain substances. That should not happen. It is easy for me to say that and to apportion blame for what happened. It is shocking that a 14 year old girl should lose her life in such tragic circumstances. While I did not know the child personally, I knew the extended family and they have been in contact with me in the past two days. To apportion blame in this case is extremely difficult because it is part of a wider situation. Again, the HSE is in the line of fire but all the services are aware of what happened. There were many associated social, housing, medical and legal problems, ending with that awful tragedy.

I am aware I am digressing but it is not easy to solve problems or to do the right thing in these cases. However, I hope that as a result of what happened the services will be able to examine this situation more closely. My information is that a number of children of the same age are doing the same thing. A period of mourning will be observed and afterwards we will try to do our best to help.

I also wish to refer to the provision of cancer treatment services. It has been a huge issue in the south east. Waterford now has a new private hospital that is treating public and private patients. It is a state-of-the-art facility. While it might not be the final solution to the problem in this regard, it is a wonderful facility in the area. The fact that it will treat public and private patients is important. I appeal to people of all political persuasions to support the concept. That has not happened thus far and, indeed, it has made things very difficult for some time.

The facility is now up and running. It is not the definitive answer to the problem that exists, given that the incidence of cancer is increasing at an alarming rate, but we hope and pray that with the availability of world class technology through the Whitfield Clinic we will move closer to everybody's great desire, which is a cure for the disease.

I appreciate the opportunity to comment on these matters and I welcome the Bill.

Photo of Jack WallJack Wall (Kildare South, Labour)
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The Minister, Deputy Harney, recently proposed a new system for funding long-term nursing care for the elderly. The starting point is the current situation in long-term care which is, as she described it, "jumbled and carefree". In an article published in The Irish Times on 14 December 2006 she summarised the position as follows:

The fact is that, up to this budget, a single person with just the non-contributory old age pension with a house worth €235,000, would qualify for zero nursing home subvention. He or his family would have to pay the full cost of care in a private nursing home.

The kernel of the issue is, therefore, who has permitted this situation to develop. The finger of blame is clearly pointed at the Minister for Health and Children and her Government colleagues who have been in power for the past ten years. How could they allow such an appalling situation to arise in the face of the unprecedented wealth being generated, where enormous budget surpluses have been the order of the day? Has she or her colleagues ever considered that one of the basic functions of the State is, through its social and health policies, to support all those who are disadvantaged and unable to care for themselves? A brief resort to Article 45.5.1° of Bunreacht na hÉireann should remind them of their role in this regard. It states: "The State pledges itself to safeguard with especial care the economic interests of the weaker sections of the community, and, where necessary, to contribute to the support of the infirm, the widow, the orphan, and the aged." In that context one wonders why my colleague, Deputy Stagg, and I receive letters from people who have children in St. John of God's at St. Raphael's in Celbridge stating their concern that because their son or daughter is in receipt of a disability allowance, old age pension or blind person's allowance there will be a deduction at source on foot of their staying in those facilities. A paragraph from one such letter states that the writer's son has never had the capacity to earn any income and is totally reliant on his family and St. Raphael's for all his needs; that his only income is a disability allowance of €165.80 per week at the time of the writing of the letter, December 2006; that the money was spent on personal items of clothing, social occasions such as swimming, cinema, bowling and special events, such as the annual holiday and the pilgrimage to Lourdes. Where does the Minister for Health and Children stand on caring for the infirm, the widowed, the orphaned and the aged?

Instead of looking after the weaker sections of the community, the Government has singled out the infirm and the aged as a special group, just because they are ill and elderly, and plans to take 80% of their income and, ultimately, 15% of their property. How can this constitute looking after the economic interests of these people? Despite the information from the Department on the nursing homes subvention, the family home is still under serious threat because, in the information supplied on the website and by the Minister, no allowance is made for a spinster or bachelor who resides with his or her parents and cared for them before they went into a nursing home. How will they be cared for? How can they deal with the bills that will mount up over the period of time their loved ones are in a nursing home? It is all right for the Minister, given the wealth of support she has in the higher echelons of earnings, to say that €100,000 is very little in the context of the value of a home in Dublin 4 worth, perhaps, €4.5 million or €5 million. In rural Ireland €100,000 is a major contribution for any family to have to make, and we will debate it until it is removed from the legislation. The family home is sacrosanct. It is the only thing people have, but the Minister continues to try to force down our throats the idea that it provides a viable opportunity for the Government to claw back money from ordinary people. We will make this an issue in the forthcoming election and if we get back into power we will reverse the Minister's policy of selling the family home over the heads of the people who cared for their loved ones before they went into a nursing home.

Photo of Emmet StaggEmmet Stagg (Kildare North, Labour)
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Hear, hear.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Hear, hear.

Photo of Jack WallJack Wall (Kildare South, Labour)
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A perusal of the policies pursued by this Government on long-term care for the elderly over the past ten years is enlightening. First, the Government has provided tax relief to encourage the development of private for-profit nursing homes. This has led to a very rapid growth in the number of private long-stay beds while the number of public long-stay beds has not been increased. Thus, we have effective privatisation by stealth. Second, the balance between public sector and private long-stay beds has changed radically. In the 1960s, four out of five such beds were in the public sector. Now, more than half are in the private sector. Third, because of the inadequate number of public sector beds, successive Governments have subsidised private beds in various ways, incurring a significant increase in costs over the past few years, instead of developing the wonderful services provided in geriatric services in the public sector. Fourth, the Government guaranteed a medical card to everyone over 70 years of age. According to the terms of the Health Act 1970, as confirmed by the Supreme Court, this meant free medical treatment and health care, including long-term residential nursing care. The Government disregarded the statutory framework and illegally charged the elderly for such care by way of deductions from their pensions. It must now reimburse those who were illegally charged for the care to which they were entitled without charge.

In 2005, this Government passed an Act making it legal to collect 80% of their pensions from older people in long-term nursing care in order to fund their care. The Minister is now building on this recent Act to put in place a system whereby older and infirm people will not only have 80% of their income, but also 15% of the value of their property, taken by the Government to fund their long-term residential care. Why should this group of people be treated differently from everyone else in terms of health care provision, especially when the vast majority of them have a medical card and could expect to receive free long-term health care? Further, most of these people have worked all their lives and made insurance contributions and are perplexed that they now have to pay for something they thought they had already paid for in the course of their working lives of service to the community and to the State.

Let no one from the Government side put forward the argument that there are now significantly more people in need of long-term care owing to an ageing population. It is clear that despite significant changes in population, the percentage of people in need of full-time care is remarkably stable. In the late 1960s and early 1970s approximately 5% of the population over the age of 65 required long-term care, while today it is approximately 4.6%.

There have been three recent reports on care of the elderly — the report of Professor Eamon O'Shea, which deals with the issue of funding nursing home care; the Mercer report, A Study to Examine the Future Financing of Long Term Care in Ireland; and the recent report of the National Economic Social Forum, Action Plan to Reform Care Services for the Elderly. We therefore have a plethora of analysis and information about this surprisingly small number of people, which today numbers some 20,000 people in total, and which is expected to rise to just 22,000 by 2011. Even by 2050, both Mercer and the NESF predict that Ireland will have fewer people over the age of 65 as a percentage of population than the European average. Further, the most recent CSO statistics show that our fertility rate is the highest in Europe, so that the number of young people will also be growing. These will be income earners paying tax and providing support for the elderly in the next 30 to 40 years. Moreover, long-term care is a misnomer since, according to the O'Shea report, 77% of those in such care are in a nursing home for three months or less. The Department of Health and Children's annual statistics also show that of those discharged from nursing home care in any one year, 20% die, but 63% are discharged back into the community. There are therefore few people who stay for years in long-term nursing home care. The average period of such care does not exceed three years, yet the Government continually states that these people or their dependants, depending on the category of dependant, will have to sell the family home to pay for the cost of caring for a small percentage of our aging population in nursing homes.

There is, of course, a severe financial crisis for those individuals who are unfortunate enough to need nursing home care, and for their families. They find, as the Minister herself puts it, that no person can be sure at present whether they will get a public or private bed or how much they will have to pay. This crisis has been created largely by the current Government's actions as outlined above and its manifest reluctance to invest in the provision of public nursing home beds. To argue that there is a severe financial crisis for the Government in providing for the adequate care of a cohort of 20,000 is patently ridiculous. To define as a crisis the future burden to the State of providing adequate residential care for older people is an example of ageism at its worst.

The Minister, Deputy Harney, should read the NESF report with great care and especially its focus on the need to root out ageism in society. It is a fact that older people remain quite healthy, independent and able to enjoy life until the end of their lives.

I was recently involved with a group of older people in Athy. It was wonderful to see their participation and all they wanted was for the entertainment, involvement and companionship to continue. Yet, the Minister picks out a small number of older people who require institutional care and proposes that not alone must they pay over 80% of their income but she will effectively charge them 15% of the value of their property in the form of a deferred tax payable after their death. This is an unbelievable and faulty position and it leaves behind groups of people such as bachelors, spinsters and carers who are not covered in any shape or form in the information provided by the Minister with regard to the nursing home subvention.

Reference is made to persons with a disability as being the only group excused from meeting the costs by means of their parents' estate. I reiterate that the family home is the one heirloom left to a family and it will still be under threat, despite what the Minister says. Her only explanation is a reference to a similar funding method operating in the United Kingdom. This is not a sound basis for advancing this method of financing the provision of long-term care and it is easily countered by the O'Shea report which points out that most European countries rely upon state funding for long-term care through either social insurance or general taxation.

The British Royal Commission on long-term care found that the costs of public provision for nursing home care for an older and healthier population can be met within the parameters of all reasonable forecasts of economic growth. For the past decade, Ireland has experienced unprecedented economic growth which has significantly exceeded that achieved in Britain in the same period. This fact undermines the Minister's argument which she mounts in an attempt to foist the system upon the older people needing long-term care from 1 January 2008.

The provision and funding of adequate nursing home care is only one part of the State's care for older people. It has been Government policy for many years that nursing home care should always be a last resort and that as many people as possible should be enabled to live an independent life in their own homes for as long as possible through adequate home care services such as home helps and meals on wheels. Despite the Minister's claims to the contrary, the Government has done very little to improve home care services. The number of home helps employed by her Department declined by 19% between 2001 and 2005, although I acknowledge that a significant increase in home help hours is promised for 2007.

Ireland ranks very poorly when compared to other countries in terms of home help services provided. An OECD study in 2005 shows that only 5% of Ireland's over-65s receive any home benefits compared to 15% in Australia, 18% in Norway and more than 20% in the UK. A study comparing home care in the Republic and Northern Ireland put the Republic's rate at 7% compared to 17% in the North. Furthermore, as the NESF report points out, Ireland spends much less of its total expenditure on care for older people than other OECD countries, spending just 0.67% of GDP compared to the OECD average of 1%. The NESF report recommends that Ireland should increase its expenditure on older people up to the OECD average, arguing that with a healthy economy and high growth rates, the country's finances can easily bear the extra cost.

The NESF report sets out a detailed programme for the development of comprehensive and well-integrated home care services. The key factors for older people themselves, according to a survey by the NESF, were housing and transport. Housing improvements such as better insulation and safer facilities are often needed and we must put in place a significant increase in the provision of sheltered housing. For the rural elderly in particular, good public transport services can make the difference between a good quality of life and total isolation. The rural transport initiative must be extended to cover the whole of rural Ireland. A recent statement by the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, did not go down well with the people I represent and who want our rural transport initiative to service the hospitals, day-care centres and places where people can go to enjoy themselves or visit their loved ones. They did not want a night service which they regarded as being a security risk and which would cause further isolation.

Three further requirements for effective and comprehensive home care services which will enable older people to stay in their own homes — which is where they want to be — are the concept of the integration of services; statutory entitlement to services; and universal entitlement to services.

As any carer will tell one, there is currently little or no integration of the services provided by different Departments. The interdepartmental group on the needs of elderly people was established in 1992. The Health Act 2004 required that the HSE should integrate health and personal social services. The NESF demanded that the Departments of Health and Children and Social and Family Affairs should jointly establish a broad-based group to develop a national strategy for carers by January 2007. This is now due in March 2007. There is little sign on the ground of any activity from any of these groups, yet we know that there is now also a need to integrate housing and transport policy.

Both Mercer and the NESF argue that there must be statutory entitlement to home care services. This is to give those who need these services stability and security in the knowledge that their services will not be removed at the whim of a Minister, or more pertinently, the Minister for Finance, when money is tight and that they can claim a legal entitlement to them.

The universal entitlement to services will be greeted with horror by any Progressive Democrat Minister. The argument for universal entitlement in home care for the elderly is a simple and logical one, expressed most clearly in the Mercer report. More than 90% of older people in Ireland have an income of €254 or less per week. It is a waste of Civil Service time and money to undertake detailed and complex means testing of all older people just to pick out fewer than 10% of this particular group who have higher incomes. By far the most efficient and cheapest system in such a case is universal entitlement for all those who are shown by a needs assessment to require home care.

Older people and carers struggle with the many different means tests which are inflicted upon them to see whether they qualify for different services. Many of the tests are very discretionary and it depends on where one lives or who is administering the tests as to whether the service is provided. This is not a fair method of caring for a very vulnerable group.

In her approach to long-term nursing home care for older people, the Minister and her colleagues in Government have allowed a most unjust and unfair situation to develop in the past ten years. This has suddenly been called a crisis. Their response, surprisingly, is not to accept the clear and professionally researched recommendation of the Mercer report that long-term care should be financed by social insurance, PRSI. Instead the Minister picks on just one small, disadvantaged group, the older and infirm, and argues that they alone, despite being medical card holders, must pay for their health care services.

I wish to highlight the effect of this on these people. This is the only means tested payment of any of the Departments of Social and Family Affairs or Health and Children. It is highly flawed in that it does not cover family members who may have been resident in the family home for 40 or 50 years and when the parent dies in a nursing home, the outstanding bill could force that person to sell the family home. The home is the family heirloom, the one thing the parent or loved one wished to pass on to them.

The Minister is turning the whole social welfare and health care support system on its head. In any civilised society, it is considered the country's duty to provide financial support through taxation and PRSI for those who are disadvantaged and ill. Those at work make a regular contribution through PRSI while they can afford it so that when they are out of work or retired they will be able to receive the support due from their own contributions when needed. This is clearly a better way to fund long-term care for the elderly than trying to deprive those who worked hard for so long of the heirloom they want to pass on, the family home.

12:00 pm

Photo of Tom KittTom Kitt (Minister of State (Government Chief Whip), Department of An Taoiseach; Minister of State, Department of Defence; Dublin South, Fianna Fail)
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I welcome this special debate on Second Stage of the Health Bill 2006, which provides for the establishment of the Health Information and Quality Authority and the Office of the Chief Inspector of Social Services. It is important that the House devotes time to this key issue. All Deputies are concerned about events which have come to light, specifically those in the Leas Cross nursing home, as highlighted by RTE's "Prime Time Investigates" programme. They must never be allowed to happen again. The House also heard Deputy O'Dowd relate disturbing details concerning another nursing home. I look forward to all the matters he raised being thoroughly investigated.

The Minister for Health and Children, Deputy Harney, and her Minister of State, Deputy Seán Power, who is present, have drawn up reforming legislation, including the Bill before us, in the area of elderly care. While I accept the Bill is overdue, the Minister is anxious to get it right. The office to be established under the legislation will have statutory functions which will ensure uniform standards of quality and safety throughout the health service.

As the Minister noted yesterday, the provisions on whistleblowers are a key feature of the Bill which will protect those who report medical and welfare malpractice. The Taoiseach and other Ministers have been asked about whistleblowers legislation on many occasions. The Government's commitment to deal with whistleblowing on a sectoral basis is reflected in the Bill. Employees who disclose and highlight wrongdoing will be protected, thus strengthening the system and adding another layer of protection for patients. Some of the incidents raised earlier by Deputy O'Dowd will be covered by the new provisions on whistleblowers. The legislation also introduces a new registration process, a matter I propose to address later.

The Health Information and Quality Authority, HIQA, will have an extensive role which will include undertaking investigations as to the safety, quality and standards of service where the Minister believes there is a serious risk to the health and welfare of a patient and carrying out assessments of health technologies, including drugs and medical devices. In light of the many reports Deputies hear concerning errors in prescribing drugs, it is welcome that HIQA will assume a function in this area.

The key provision is the establishment of the office of the chief inspector of social services, an HIQA employee with independent statutory functions and responsibility for inspecting residential centres, both public and private. The chief inspector will have responsibility for ensuring that all nursing homes, including the centre in Cork to which Deputy O'Dowd referred, and public and private homes for people with disabilities and children are registered. The office will also have the power to inspect special care units for children. It will oversee the performance of the Health Service Executive in respect of standards in fostering and pre-school services and the boarding out of elderly people. The chief inspector will have extensive powers in carrying out inspections and may enter a centre, examine records, take copies of documents and other relevant items. He or she will also have the power to investigate, where required, and staff of a centre may be interviewed in private.

In addition, residential centres will have to be registered by the chief inspector and it will be an offence to operate without registration. Registration details will be available to members of the public on the Internet, a further important development in terms of transparency. The chief inspector may cancel a registration if standards are not met and seek an urgent cancellation of a registration before the District Court if he or she believes there is a risk to life or a serious risk to the health or welfare of residents of a centre. This is strong legislation which responds to an urgent need.

This debate gives the House an opportunity to examine the broader issue of how society treats elderly people. The Government has honoured its commitment to promote care for older people through budget increases for pensioners and initiatives such as the free travel and free fuel schemes. People live longer — in many cases into their 80s and 90s — and the vast majority of older people live healthy and independent lives in their own homes. More than 21,000 people, or approximately 4.6% of those aged 65 years and over, live in long-term residential care centres. It is predicted that the number of those in residential nursing home care will increase to 44,000 by 2036 and 61,000 by 2050, a reduction in the proportion of those needing such care from 4.6% to 4%.

The Minister for Finance, in launching the national development plan, noted that Ireland's demographics offer us an opportunity to complete major infrastructural developments and improvements in our social services, the latter through important social inclusion measures announced at the launch. He also pointed out as the population will be much older in 30 or 40 years from now, we need to complete this work at this time when resources are available and demographics are right.

Our focus must be firmly set on giving older people the opportunity to live independently in their homes for as long as possible. The Government has correctly invested heavily in community and family support systems. These initiatives will mean that more older people who require low or moderate levels of care will be able to stay at home for longer. I agree with the Minister for Health and Children that past policies addressed the needs of older people from a dependency perspective but that the focus has changed to promoting independent, healthy lives for older people. Increased pensions, free travel and free fuel are not hand-outs but rights to which older members of society are entitled, having worked hard, made sacrifices in more difficult times and helped build the strong economy and society we all enjoy.

Following the increases in pensions and the carer's allowance announced in the budget, I welcome the strong focus on older people in the new National Development Plan, 2007 to 2013. A sum of €9.7 billion will be invested in the older people programme, of which €4.7 billion will be allocated for the living at home sub-programme with a further €5 billion allocated to the residential care sub-programme.

The national development plan correctly recognises that older people are one of the main groups at risk of social exclusion, while the partnership agreement, Towards 2016, sets out a vision of how older people can maintain their health and well-being and live as long a life as possible in an independent manner. The plan deals with important areas of support for older people, including social housing, essential house repairs, improvement in primary health care facilities, the rural transport initiative, education and training and support through community organisations to improve the security of older people.

Recently, I had the privilege of officiating at an event organised by Roscommon Home Services, one of many voluntary, not-for-profit organisations doing tremendous work in communities. Established a number of years ago, Roscommon Home Services recruits and trains local people and has approximately 200 employees on its books who provide a range of support services for people in their homes, particularly elderly people, in counties Roscommon, Mayo, Leitrim and Galway. A reasonable, nominal fee is charged for these services which assist elderly people in home management, cleaning, gardening, social care and general elderly care. In many cases, the older person is simply delighted that someone calls to do some work and have a chat. This vital aspect of the tremendous work being done in many communities is not always recognised. There is less community activity in many parts of the country because people have less time to converse and interact. In this case, however, it is the kind of service I strongly commend. The Government is anxious to support this kind of work through Pobal in particular.

As regards the living at home programme, the use of community and home-based care will be maximised and will complement the role of informal care, including family care. Under the national development plan, home care packages will deliver a wide range of services which will include the services of nurses, home care attendants, home help and various therapists, including physiotherapists and occupational therapists. The support scheme is also available to older people who have been admitted to long-term care and who now wish to return to the community. The packages will be delivered by the HSE, voluntary groups and the private sector.

Community intervention teams will assist in preventing avoidable hospital admissions and the facilitation of early discharge from hospitals. These teams will operate in addition to existing mainstream community services. Day care services will continue to be expanded.

Some €5 billion will be invested in residential care over the period of the plan. The increasing older population will require more residential care places to be met by public and private providers. It is proposed to develop community units, each with a capacity of about 50 beds, at a number of locations in Dublin, Cork and other sites around the country. The range of services includes convalescent care, respite care and long-term care. As I stated earlier, Government policy for the elderly has long been to support older people to live in dignity and independence in their homes and communities for as long as possible and to support appropriate long-term care where this is no longer possible.

I wish to deal with another area that is close to my heart and comes within my remit, which is the question of new technology and older people. Other Deputies will share my interest in this matter because technology can be of great benefit to older people. Since taking over responsibility for the information society in the Department of the Taoiseach, I have prioritised a key objective of giving older people the opportunity and encouragement to use modern technology. The use of modern technology is an important means of improving the quality of life for older people and we must involve older people as important members of and participants in what is termed the information or knowledge society. The Internet is part and parcel of the lives of our younger population, but since its arrival many older people now have opportunities for a new level of self-development and fulfilment. The lack of these opportunities had held many people back before now but they currently have the facilities that can enrich their lives, especially as they face into their autumn years. They will have the chance to pursue a niche activity or interest that was not possible when the barriers of communication and personal circumstances confined them to a narrower world.

Health experts tell us that the key to physical health is often more to do with mental attitude and well-being. As more and more people are living alone, communication via a proper communications infrastructure is an important foundation on which to build a good quality of life. Before the advent of the information age, people who are physically restrained had to live with the frustration of an agile mind as old age set in. The ability to communicate more widely is now a key to their happiness and quality of living. This is where access to all modern communications technology, including the Internet, has great potential for improving the situation in people find themselves. Such access also allows their creativity, experience and wisdom to be of value to themselves and those who care for them. It can be a great comfort and support for many carers to communicate with other carers, share their experiences, learn from others and add to the store of knowledge about the circumstances with which they must cope.

I launched the access, skills and content information society, an initiative introduced to tackle the digital divide in society, to attract more people to use technology for their own benefit. The programme is specifically targeted at older people and those with disabilities. It is designed to support projects that focus on creating meaningful content, as well as the skills necessary to access and use that content. Such content can be of value to people who benefit from participation in networks or partnerships, whether they consist simply of improved contact with family members, access to information, supply of goods and services, education, research, or in the pursuit of an interest that may have been curtailed due to location or mobility constraints. The initiative has been a great success and I will continue with it this year by issuing a call for proposals from interested groups next month.

Technology has many applications. In the health area, for example, developments in medical technology have been astonishing and have contributed hugely to the increasing survival rates of older people. Technology has also changed the way in which education can be delivered and has made it possible to access a rich variety of educational content in a manner that meets individual needs in terms of time, presentation and resources. In that respect, it has opened up new windows to those for whom more conventional and traditional facilities might not have been suited.

The Internet has opened up access to a variety of sources of useful information and knowledge, so that people can gain access to lifestyle advice to suit their particular needs and circumstances. It allows people to develop old or new interests, gain new skills and establish their worth and contribution to society. In these ways, they are getting new opportunities for participation as valued members of society and can even contemplate new careers in later life. In terms of cultural and recreational activities, especially niche interests and activities that do not have a significant local presence, participation in on-line communities of interest opens up possibilities of self-realisation for all age groups. Fundamentally, modern communication technologies have made it possible for everybody to enter into mutually beneficial partnerships and relationships that promote greater independence, self-esteem and, ultimately, a better quality of life.

Happily, older people today enjoy robust health for many years into their retirement. Catering for the needs of the elderly is therefore not specifically a health issue. It has more to do with the quality of their lives and their self-esteem. Access to the rich resources now available 24 hours a day, seven days a week, has opened up tremendous possibilities. Through the access, skills and content initiative, I hope to continue to promote those values and show how technology can work to liberate people, rather than generating fear and mistrust.

Projects are under way to examine how ambient technology can be used to promote independent living. However, it is also important to remember that people need to feel part of a community, to feel that their existence is valued, and for them to be respected for what they are as well as for what they have contributed to society throughout their lives. Through technology-enabled networking, being part of a community has taken on a new complexion and has made it possible for more vibrant communities of people who share common interests or circumstances to help each other and to continue to develop as human beings. I wanted to put on the record my views on how technology can be of great benefit to older people. Having spoken to members of active retirement groups, I know they are finding the use of new technology to be extremely beneficial.

I welcome this legislation which will allow for a fully independent inspectorate for all nursing homes for older people, both public and private, as well as for centres for people with disabilities and children. The Bill is central to the Government's reform programme for the health service as we strive to achieve a safer health and social services system.

Whatever Government is in power, we must continue to give people an opportunity to pursue independent, healthy lifestyles. While we all agree on that point, we must also recognise the serious flaws in nursing home legislation in the past. The Bill before us is significant in this respect. The quality of service and care in the vast majority of nursing homes is good. In our family lives we have all had experience of such care provided by management and staff of many nursing homes throughout the country. It is in the interest of nursing homes, as well as patients, that we should get this legislation through the House as quickly as possible.

The matters raised this morning by Deputy O'Dowd were shameful. It is important to use this legislation to root out those who have been involved in such activity in nursing homes and other institutions. Those who genuinely care for the elderly should be allowed to get on with their work. Many Deputies have rightly recognised that a large number of dedicated people are providing tremendous care. The Minister for Health and Children and the Minister of State, Deputy Seán Power, deserve credit for bringing forward the Bill. It is one of many reforming measures they have introduced.

This is a difficult area for a ministry to get right all of the time. Dreadful mistakes have been made, which must be recognised. I commend RTE's "Prime Time" in particular for what it exposed with regard to Leas Cross, and we have had other reports since. All of these cases should be thoroughly investigated and all of the facts made fully known. The Bill will ensure, through the transparency measures and the strict regime involved, that those situations will not arise again.

I commend the Bill to the House and I commend the Minister and the Minister of State for the work they have done. I urge them to continue to bring this legislation through the House. As Chief Whip, I will certainly play my part to ensure we get it through as quickly as possible.

Photo of Séamus HealySéamus Healy (Tipperary South, Independent)
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I wish to share time with Deputy Boyle.

Photo of Rory O'HanlonRory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Is that agreed? Agreed.

Photo of Séamus HealySéamus Healy (Tipperary South, Independent)
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I welcome the debate and I welcome the Bill, which is long awaited and not before time. In recent times disturbing reports and details have emerged from private nursing homes and there is no doubt a robust inspection system is urgently needed. I believe the operators of private nursing homes and public hospitals will generally welcome the legislation and the regulations that will arise from it.

There is a sense in which both Government and Opposition want the legislation to pass through the House as quickly as possible but it must be considered in detail also. While the detailed forensic examination of the Bill is for Committee Stage, not for this debate where more general comment is appropriate, I welcome the Minister's intention to include a whistleblower section. There is no point in having world class high standards of legislation and regulation if we do not have the will and resources to implement the legislation and regulations. This has happened too often in the past. We have had good quality legislation and excellent regulations but little or no will or resources to implement them. I hope in this case the resources are provided and that the will is evident to implement the Bill when it becomes law.

A disturbing matter has come to my attention in recent weeks. Consequent on the Minister's indication that there would be an increase from 1 January in nursing home subvention, it appears nursing homes have routinely notified residents and their families of increased rates. This appears to be happening on a universal basis and one would wonder if the word "cartel" might be appropriate to what is taking place. The effect is that the increase in subvention will have little or no positive effect for most residents of nursing homes. I bring this to the attention of the Minister of State, Deputy Seán Power, who might consider the situation to find what might be done in this regard.

As I noted, this debate is for more general comment. We have repeatedly heard during the course of the debate the phrase "so much money has been put into the health service". Of course, if this is said often enough, it becomes a "fact", whereas the real facts are that we are not funding health services to even average EU levels and there is a major deficit due to under-funding in the past 20 years. We are not providing enough finance for the health services, even as we speak. We have much time and funding to make up due to the deficiencies of past years.

On the question of reform, repeated reference has been made to one of the Minister's reforms. I must record my concern and those of many Opposition Members at the establishment of the Health Service Executive. We were concerned that it would not help the situation and, unfortunately, those fears have been confirmed. The HSE is more bureaucratic, more centralised, less accountable, less responsive and less transparent than the previous system ever was. There is no accountability to the public, local public representatives or the House, although the Minister told us when she was putting through the legislation that we could ask any question we liked and we would get an answer. That has not happened and will not happen.

This had led to an unfortunate situation where local health staff, particularly at managerial level, have effectively become paper pushers and the bureaucracy is significantly worse than ever before. An example of this comes from my constituency town of Carrick-on-Suir, which has been seeking an emergency ambulance service for years. It has been accepted by the local people and their doctors and public representatives, as well as ambulance and health service personnel, that the service is necessary. However, it has been found necessary to go through another paper exercise to satisfy the HSE, which must have another investigation. I am sure that in the months to come it will think up another investigation to ensure the service is not provided. The Minister must examine this matter to find whether it can be progressed. An emergency ambulance station is vitally needed in Carrick-on-Suir.

With regard to the elderly, we have heard for years that nursing homes and long-stay institutions must be a last resort, which is the case. Much lip service has been paid to this issue but there has been no prioritisation of the facilities and services needed to keep elderly people comfortably and securely at home in their communities. I welcome the involvement of voluntary organisations, which are of vital importance to the effort to keep elderly people at home. However, far too much work is left to such organisations. We need more home helps, not less, as was the case last year. We need more meals on wheels services, day-care centres and chiropody services, which are now non-existent for elderly people at home. There is an 18-month waiting list for elderly people to be seen for a simple thing like a hearing aid. The position is similar with regard to eye-testing, for which there is a 12-month waiting list, and the absence of laundry services is a further example. Such problems do not help to keep an elderly person at home but make him or her more dependent. These services need to be put in place in the community.

If we are not just paying lip service and are real about wanting to keep elderly people at home — secure, comfortable and involved in their local communities — we must put these services in place and make the necessary resources available. We should not leave this work completely to local voluntary organisations, such as those which complain to me that their FÁS workers are being withdrawn. It is not good enough. I suggest that if the Government wants to treat the elderly fairly and equitably, it must establish the necessary services in local communities and in their homes. This would be a cheaper option than residential care and it should be done.

Photo of Dan BoyleDan Boyle (Cork South Central, Green Party)
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The Bill has been described in this Chamber as reforming legislation, but unfortunately it is reactive legislation. The argument for an independent inspectorate of nursing homes and residential institutions has long been made, but is only reluctantly being acceded to. The system that was in place was clearly unsuccessful and the deletion of certain sections of the Health (Nursing Homes) Act 1990 demonstrates the Government has finally come to that conclusion. It is by no means a coincidence that it was a Fianna Fáil-Progressive Democrats Government that enacted that legislation. We are not just talking about the need to establish consistent and humane standards of care for the elderly, but also the philosophy of that care. I wish to speak about measures in the Bill that undermine the premise that care can be provided humanely in the future.

The health boards and their successor, the Health Service Executive, are the last bodies that should have been involved in the monitoring and regulation of residential institutions and nursing homes because they have too many vested interests. Too many compromised interests were involved in such an inspection process. A see no evil approach was adopted because of the need to keep people in residential care in order that they would not become, as obscenely described in debate, bed blockers. On account of that attitude, the economics of health care were paramount in the framing of our policy. We have seen the net result of this in exposures through the national media.

Not only were compromises in place, the resources needed to conduct a valid inspection have not been available since the enactment of the Health (Nursing Homes) Act 1990. We have examples of institutions that were never inspected over many years. Where reports were produced there are damning indictments of the institutions in question, but no actions were taken. On those grounds, the existing system has been an utter failure. It is time for an independent inspectorate to try to correct past mistakes and ensure they do not recur.

I have some concerns about whether this legislation as framed can do this. The establishment of the Office of Chief Inspector of Social Services undoubtedly creates an independent office. However, the remit of that office, which covers residential nursing homes and residential institutions for people with disabilities and children in care, seems very broad. We must ask what resources will be available to an office with such a large remit. If the mistakes of the past are repeated because of a lack of resources, we will continue to have a situation where many residential institutions will not be inspected over long periods. If the House merely replicates the 1990 Act in another form, it does the country a disservice.

The remit of the Health Information and Quality Authority also gives rise to concern, in particular the provision relating to charging for services other than for information given to the Minister, the HSE or other public service sectors. This indicates the philosophy held by the Minister for Health and Children that health and care services can best be provided through the private sector. If we establish a body that is meant to act on largely commercial principles in carrying out its remit of obtaining care standards — care that will, according to the Government, be provided in the private sector — the House will have done a bad day's work.

The Government has failed utterly in the care of elderly people. We have heard that 5% of the elderly population is catered for in residential institutions. Not only have some of this 5% suffered physical and emotional abuse, they have also suffered economic abuse through the manner in which their payments were stopped. They also suffered environmental abuse in terms of their living conditions and the preparation of their food, as articulately illustrated by Deputy O'Dowd.

Questions must also be asked about the Government's philosophy towards the care of the other 95% of our elderly, mainly provided through family or voluntary resources. To a large extent, the Government has failed to come through in this regard. Efforts to be cost effective have led to penny-pinching and a reduction in the home help service. Voluntary bodies have had to pick up the slack and they are largely unsupported in the provision of services that the State should provide. Not only do they provide the services, they must also spend much of their time and resources fundraising to meet their commitments. As long as that philosophy continues, the Government's credibility on the issue of care of the elderly must be questioned.

I use this opportunity to speak on the wider issue of the economic abuse of people in nursing homes, which was one of the triggers for the wider debate. Unfortunately, the debate continues as more discoveries and disclosures are made. A further story is reported in the media today regarding how health boards and the HSE held on to the interest earned from the income of people in residential care. If this debate was not being held in the artificial circumstances of the Order of Business decided before the House rose in December, we would have the opportunity for a direct statement from the Minister for Health and Children on how this anomaly and further injustice to people in care will be corrected. That statement should be made at the earliest opportunity, next week when the House has properly convened.

The report in today's media states that at least €1.5 million in interest withheld for 2005 alone will be returned to people. We know that the situation regarding the moneys of people in nursing homes goes back over 30 years, to the 1970s. If we aggregate the projected interest over a 30 year period — we should remember that interest rates for much of that period were in high double figures — we recognise the need for a serious statement to be made to the House. Members must be allowed to question the Minister on what appears to be the withholding of further information as to the true extent of the problem. Perhaps the Minister or a Minister of State will take the opportunity to comment on the conclusion of this debate. If it was on the record it would allow us have a wider debate when the House properly convenes next week.

One of the aspects of the Bill I found most interesting relates to the Schedule which repeals many of the sections of previous health care legislation. This debate has been informed by the need to discuss care of the elderly so there has been little debate on whether the additional functions of the chief inspector of social services with regard to people with disabilities and children in residential care are adequately covered in the Bill. Unfortunately, this is due to the truncated nature of this debate. Owing to the Order of Business last December, we have no opportunity to have that debate. I ask that the Government give more emphasis to that on Committee and Report Stages. I fear that by passing this legislation we will allow a lack of proper consideration in two areas of care. The nature of this debate means that they are not being properly considered.

On those grounds, although the Green Party supports the establishment of the Health Information and Quality Authority and the Office of the Chief Inspector of Social Services, there are real concerns. There is a need for wider debate and for the legislative process to be worked through properly in this House. Many of us still need to be convinced that this legislation, once on the Statute Book, will deal with needs that sadly still exist in society.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I propose to share time with Deputy Neville. Each of us has at least 20 minutes to speak in this debate and I would hate to think that the House might adjourn early when, owing to time constraints, we have been forced to share time.

Several issues must be addressed regarding this legislation. I have listened with interest to the various speakers who have welcomed the legislation and said that without it, we should not and could not proceed. However, that is not the case. Legislation was already in place to ensure that adequate inspections took place in all institutions and that the legal standards and guidelines were observed. Why they were not enforced in the cases referred to I do not know. To suggest in any quarter that the laws or available resources were insufficient is absolute balderdash. There is no question that what was lacking was the will.

Some 25 years ago, adequate procedures were put in place to ensure that the highest possible standards prevailed in all institutions. Criticism used to be levelled at the health boards that they were not enforcing legislation in their own institutions that applied to others. When people on the Government side of the House or anywhere else complain that the legislation is not there to ensure that the highest standards prevail, that is absolute and total rubbish.

I point out that a great number — the vast majority — of nursing homes in this country do a great job, providing a very high quality, compassionate and caring service. They are controlled and managed by people with the patients' interests at heart. Without their services in recent years, it would not have been possible to cater for those who required intensive nursing care. I pay particular compliment to the public in nursing homes and hospitals that provide geriatric care and in some cases psychogeriatric care. They rendered a tremendously compassionate and caring service, setting a very high standard.

Against that backdrop, the suggestion that legislation needs to be introduced or amended is absolute tommyrot, and I reject it in its entirety. Such a situation never obtained and it is only because people would not do their job when asked that this has happened. That has become quite commonplace and the HSE is a total failure.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Hear, hear.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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It is unlikely to succeed in anything it undertakes. It is top-heavy in bureaucracy and administration, with various contradictory opinions, and expertise. It is overloaded, overburdened and unworkable.

Some time ago I listened to a radio programme on MRSA. The presenter asked where were the hygiene inspectors. That is a good question, and the answer is that they have been sacked. The health boards that provided them were abolished. It was they who were supposed to go around public and private hospitals every week and ascertain whether procedures were being adhered to. It was all done for reasons of political expediency. In the run-up to a general election, the then Minister decided to sacrifice the health boards to "save money". He did not save too much because expenditure has reached previously unknown levels, with services still not delivered. The appalling aspect to this is that service levels are still falling.

Let us consider what is happening. There are substantial system failures everywhere and a total rejection on the part of the bureaucracy of any authority or accountability. There is no willingness to give the public the service they deserve in keeping with modern requirements and expenditure. A bureaucracy is developing that is orientated more towards employment than delivering the service to the people as intended.

For example, in my constituency in the past week a person went to the relevant official in the health service in an emergency. When that person said that representations had been made to me in my capacity as the local Deputy, the question was asked why one went to him given that he could do nothing for anyone and is only interested in people's votes. In such cases the matter is then raised with the superior officer, who has no authority because he withdraws into the mode of bureaucracy and says the person should direct future queries elsewhere.

That is system failure because of an unwillingness on the part of the individual to treat the job with respect and attend to it. Unless that and similar issues are urgently addressed in the Department of Health and Children, which has become the massive bureaucracy of the HSE, there will be more systems failure. We have heard Deputies across the House mention various parts of the country where references made by Deputies or others, including doctors, are now routinely ignored. The general attitude is to ask what the hell they know and why one should respond to them. Where that attitude prevails, there will be more failure and tragedy. The quicker the Government and those in control realise that, the better for them.

For example, in the past six months I had occasion to refer at least three cases of children at risk to the Departments of Justice, Equality and Law Reform, Education and Science and Health and Children. The first line of resistance was their reluctance to answer parliamentary questions. They were said to be of no relevance, while the Minister apparently had no responsibility, but that is rubbish. An unwillingness to deal with the issue lay behind it.

After a long battle to get answers to my questions, the Department of Education and Science was a total failure. The National Educational Welfare Board was severely under-resourced and did not work for children at risk, so that they remained at risk. To be fair to the Garda junior liaison service, it did its job. It received a great deal of criticism, and I would be the first to join in that, but it did its job and addressed the issue as far as possible. The Department of Health and Children was a total wash-out, with no response whatsoever. It went into defensive mode straight away, stating that the matters were confidential and that it could not talk to me about such issues because confidentiality covered everything. That is a total and absolute disgrace.

We hear media comments suggesting that ordinary, vulgar Deputies should not ask such questions because they are people with red shoes, red noses and blue suits. They think that we should not deign to ask questions of this nature and hope for more intellectual inquiries. I reject that notion. Unfortunately, some of the media, like the rest of this country, are being managed by the Government. They are being drip-fed and cannot move away. That is the way everything is being managed and eventually people will start to manage the Opposition. In the delivery of health services required there should be clear recognition of the duty of the Government and the Minister to ensure clarity, accountability and transparency. Political responsibility should be accepted rather than sacking the Secretary General of the Department when matters get rough. From time to time we must admit we have made mistakes.

Regarding the children's hospital, about which we have heard so much expert opinion, I have never heard such rubbish as the suggestion that the location should be where public transport services converge. That is the last place it should be located. Who brings a child to hospital on the Luas, Dart or the bus? It should be located on the basis of ease of access, parking and ensuring that all people can receive treatment there. It should not be located for the convenience of those who believe they have a superior opinion to the red-shoed, blue-suited, red-nosed Deputies in the Dáil.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I am disappointed this Bill fails to make protection of all patients its aim. Specifically, it excludes private and public psychiatric institutions and compounds the stigmatisation of psychiatric patients. The Bill falls short of proposals for a patient safety authority made by Fine Gael and Labour, which would have offered protection to all patients in the health services. This second rate solution includes protection for whistleblowers, sprung on us at the last minute, without providing details on how it will operate. This aspect will only be debated after Second Stage.

The Bill does not include an advocacy role for patients and this illustrates the failure of the Government to take the views of the public on board when formulating legislation that affects the well-being of the public. A Vision for Change proposed an advocacy role for patients and their families. This is not included in the Bill even though patients and their families should have a role in influencing Government legislation. The Health Information and Quality Authority has been conferred with several distinct roles and a scope so broad that it will fulfil none of its roles well, impeding patient safety.

The need for patient safety measures could not be clearer, as highlighted by the report on Dr. Neary. In recent times, the scandal at Leas Cross exposed horrendous conditions in some nursing homes. I refer also to Mr. Pat Joe Walsh and the death of Ms Anne Carroll on 17 October at Cork University Hospital, hours after being readmitted to the psychiatric unit, and the death of Ms Anne O'Rahilly in 2002 within 13 hours of being admitted to the Mid-Western Regional Hospital, Limerick. In the latter case, the High Court made a compensatory award that will never compensate the family for its trauma. A record number of patients are lying on trolleys in our accident and emergency units and MRSA and other hospital acquired infections are in our hospital wards. Such patient safety matters demand an appropriate response. This proposal falls short of protecting patients in all settings and will create conflicting roles that will impede the objective of patient safety.

The omission of psychiatric institutions is one of the defects of the Bill. I urge the Minister to re-examine this. The Mental Health Commission examines units with regard to the delivery of psychiatric services. A broader examination of patient protection should apply because exclusion stigmatises psychiatric illness further. At a press conference yesterday, the Irish Psychiatric Association stated that nothing has happened in the 12 months since A Vision for Change was published and accepted as Government policy. The experience of the association is that its degree of enthusiasm was not matched by the Minister and the Department. The association referred to betrayal and disappointment at the approach of the Minister, the Department and the HSE. It was disappointed and dismayed at the rate at which the Government is implementing the recommendations of A Vision for Change. The association issued a wake-up call for the Government with regard to the work that remains to be done.

A key recommendation of A Vision for Change was the establishment of community based, multidisciplinary units to serve those with a psychiatric illness. This was proposed 22 years ago in a report to the Government but was never implemented. No such community based team exists in Ireland. One third of the community based teams had less than 50% of the recommended staff number. Last year 24 posts were sanctioned where A Vision for Change recommends 650, a figure the Government was committed to filling in seven years. Now it states that this will be completed in ten years but, at the current rate of progress, it will take 25 years to fulfil the recommendations on psychiatry, psychotherapy, occupational therapy, family therapy and nursing made last year in order to create a 21st century service.

The inequity of the service has not been addressed at all, despite it being evident in a report from four or five years ago from the Irish College of Psychiatry. It indicated that wealthier areas have a much better service than poorer areas in the State, with this being particularly evident in the capital city. This issue has not been addressed and there has been no movement in 12 months to the large catchment areas recommended for delivery of the service.

The capital development area was yesterday described as shameful, shabby and shoddy. These are not my words but those of the Irish Psychiatric Association. There is no capital plan to enable the development of the required units. In A Vision for Change, it was highlighted by the Government that the assets available to the psychiatric service would be sold to provide necessary infrastructure. In a time of plenty, psychiatric services deserve money out of State coffers and should not have to sell off their assets. Be that as it may and accepting that assets will be sold, there has been no plan to move on this even 12 months down the line.

In order to provide multidisciplinary teams we need capital investment, which will ensure that if a psychotherapist, psychologist or occupational therapist is brought into the community, there will be an office for them to work out of and an area in which to meet patients. Such facilities do not exist at the moment.

The national mental health directive, a key factor in A Vision for Change, has not been introduced, despite it being cost-neutral. The Government does not even have an interest in introducing crucial components to the psychiatric service even when they are cost-neutral.

I will not speak much about the embargo, an issue I raised this morning in a meeting of the Joint Committee on Health and Children. I was told there was no embargo but a ceiling on the number of people who can be employed. Perhaps the Minister of State can explain the difference between an embargo and a ceiling on the number of people who can be employed. The reaction of the joint committee this morning was a guffaw.

It is extremely disappointing that despite our efforts last year, the level of investment in the psychiatric service was just 7.3% of the total health board service budget. The level ten years ago was 11% and it will be less than 6% this year. Is that progress?

Photo of John DeasyJohn Deasy (Waterford, Fine Gael)
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I welcome this debate and the emphasis on accountability therein. I wish to discuss social services within the HSE, and I hope I will be afforded some latitude to deal with this issue and specifically the care of young children.

I wish to raise the case of a 14 year old girl who died in my home town of Dungarvan on Sunday night. In 2005 I was contacted by a person working within the community in the town who was well aware of a situation with a particular family and was extremely concerned about the welfare of individuals within that family. She made her opinion clear that unless residential care was provided for members of the family, individuals could either die or cause the death of another. She believed the prospect to be reasonably likely.

I wrote to the HSE in the strongest and starkest terms I could, outlining the case and expressing its extreme urgency. I received no reply from the HSE and two months later I wrote to the executive again, indicating the case was very urgent and action needed to be taken. Again, I did not receive a reply.

In 2004 a case conference was held, with a recommendation emerging that these children had to be put into residential care. The recommendation, from the HSE itself, was never acted upon, which is the crux of the issue. We received a response to this case from the HSE today, with representatives explaining there had been an improvement in this particular case. I dispute that claim.

I had not previously stated this, but the initial concern came from within the HSE. It came from an employee of the HSE who went to a community worker and expressed her extreme concern that residential care was not being provided for these children. The determination had been made that if necessary, the HSE would have to go to court to get a supervisory order. If gardaí in Dungarvan were asked if they thought the situation had improved since 2004, they would characterise such a statement as laughable. Other parties would agree, and the proof is in the pudding. The child died from inhaling vapours from a can of deodorant.

We are talking about accountability, but there does not appear to be a great deal of it throughout the public services. The HSE is a good example of this. The issue should be faced up to not just in this instance, but throughout the public services. That process will start in these Houses.

There has been a systems failure, which could have resulted in this child's death. There should be an immediate review of social services and how they deal with vulnerable children. I spoke to Professor Brendan Drumm today and I believe he agrees there must be a report on the matter. I will demand that such a report be independent rather than an internal inquiry carried out by the HSE. I have tried to contact the Minister for Health and Children about the matter and she has tried to call me back. If anybody considered this matter reasonably, they would firstly have an inquiry into this specific case, but there should also be a review of the HSE's dealings with children in the social services area.

The situation is extremely grave because we are dealing with the most vulnerable people in our society. I hope I get a decent answer from the Minister once this debate is concluded.

1:00 pm

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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I am glad to see this Bill before the Dáil as it took a long time to get here. I was my party's deputy spokesman for health with Deputy Gay Mitchell in 1999 and 2000, and I raised the issue of inspectorates for public and private nursing homes in many Adjournment debates.

At that time I called into a public nursing home in north Mayo as a family had contacted me to ask me to view the conditions. I involved the then Minister of State at the Department of Health and Children, former Deputy Moffatt, what was then known as the Western Health Board, the Health and Safety Authority and the Department of Health and Children in the matter. Within a few months, €1 million was spent on that nursing home. That particular night I arrived unannounced and somebody did not want to let me in. I told them if we had visiting committees for prisons which were allowed into prisons at any hour of the night, as an elected representative I was allowed into a nursing home to see the conditions and how my constituents were being treated. What I saw that night was probably the worst I ever saw during my political career.

I compliment everybody involved in the change. A great deal of money was spent. Last week, I attended a funeral in the area and I decided to see what the facilities are like at the nursing home now. I must state they are top class and as good as any hotel in the country not to mind nursing home. It is a public facility. That change happened because I cried and shouted and got the Western Health Board, the Health and Safety Authority and the media to see what went on. That is not the way to do business but it had to be done.

The way the Western Health Board, the Minister and some elected officials responded was to do a big clean-up a few months later. The place was painted and a public day for the media and elected representatives was held. Really, it was a lashing day for me. The day which counted most was the day of the election when the people spoke. In that area, I received eight out of every ten votes cast. The public knew what I stated was correct and they responded. I am delighted the facilities improved.

I raised the issue of the inspectorate on many occasions in the Dáil. I argued the Department should get an independent inspectorate not only for private nursing homes, but also for public nursing homes. I welcome this Bill, although it is late. It is pointless having an inspectorate if it is not independent and does not have the powers to deal with situations. When I or members of the public write to it, the inspectorate must not state in reply that it has no power. I have great respect for the Office of the Ombudsman, but we have other ombudsman positions and agencies which do not have any power, such as that dealing with consumer affairs. We establish agencies and remove power from the Dáil and responsibility from the Minister. In reality, nobody takes responsibility anymore.

The elderly are frightened. If this happened in any other country, the Minister for Foreign Affairs and our great Taoiseach would lecture that country. From the day they are born until the day they die, people are taxed. This Government now proposes to tax the elderly after they die. We will have a death tax.

Elderly people will wonder whether their loved ones will be able to pay the nursing home bill after they are gone. They will have further worries on their death beds. The elderly made this country what it is today. We are the next generation of elderly people and we will be judged by the generation after us on how we treat people now. We have let down the elderly and frightened them regarding their nursing home care.

We had a changeover from the health boards to the HSE. What happened is similar to the change which occurred in local government. All that happened is bums sit on different seats. People have better pay, more perks and are answerable to nobody. I was never on a health board and have no vested interest. The media was wrong to home in on the elected members. At least when they were there they could ask questions, raise issues and make the chief executive accountable. Nobody is accountable under the new system. Everyone ran for cover.

We have never had as much money or as many people working. We make plans and spend money and are told everything is rosy in the garden. Why is it then that every day in my office and at every clinic I attend members of the public seek beds for their elderly loved ones who are entitled to them? It is said the State should provide a bed. Doctors and executives of the HSE force people entitled to public beds into the private sector and frighten them. Some people have no one to speak up for them. They have no relatives. They are frightened and do not know what to do.

Previously, when one was sick one got a doctor and a nurse. Now, when one is old the first thing one gets is a subvention form for the private sector. What is the Health Service Executive doing? It is not paid by the taxpayers to support the private sector. The private sector is well able to represent itself. If somebody is over 70 years of age, he or she has a medical card and if a doctor states he or she needs a long-term bed, it is the duty of the Health Service Executive to provide that bed. It should not throw forms seeking subventions at those people, their relatives, neighbours or friends.

What is gone wrong in this country? We used to have a sense of community. I heard the Taoiseach speaking about community. He must begin to practise what he preaches. We no longer have a community. We have become mean and people only care about themselves. Forget about the person who is sick or needs help. Forget about who we are supposed to represent, namely, the old, sick and those dependent on the State, because no-one represents them.

These people do not seek something for nothing. They worked during the 1930s, 1940s and 1950s when things were not as good as they are now. What do we do when the tide turns on them after they worked hard and paid their taxes, some of them at 60%? When they turn 70, 75 or 76 years of age they want to know a State bed is there for them. That is not happening.

I no longer know what is happening in the health service. When things were bad one could always get a GP. Recently, I attended the funeral of a man who died suddenly late at night. I am open to correction on the time but I believe it was 11 p.m. or 12 a.m. The people with him rang for a doctor and got on to WestDoc. They might as well have phoned Australia, New York or Nigeria because the first question that was asked as the man lay on the floor dying was what age he was and how was he healthwise. The people making the call wanted a doctor immediately. They did not want to know what age he was. The man died. A few hours later, somebody called to ask how to get to where the man lived.

We never paid as much money to GPs for drug subsidies or to open surgeries if they save money on drugs and we never had a worse service for the people. Nobody can be reached at weekends. One gets through to WestDoc and one is as well to get on to Australia. What has gone wrong?

Last Friday, the mother of a 24 year old man came to my clinic. The man was working after qualifying with a degree. During Christmas he lost his sight, perhaps due to a stroke. He cannot get a scan for three or four months. Why must a young lad of 24 years of age wait four months for a scan when he has his full life to live? Perhaps a great deal of damage will have been done after four months.

The Minister for Health and Children and the Government state there has never been as much money invested in health and there has never been as much money in the country. Another mother told me about her child who has a bleed at the back of her head. She has waited for a number of weeks but cannot get a bed in Beaumont Hospital.

I heard Archbishop Martin from Dublin speaking about the row about the children's hospital. We would be far better off if these boards thought of these hospitals as national hospitals and not Dublin hospitals. Why are people from throughout the country being brought into a city which is already clogged up? One cannot get up and down the streets of this city from 8 a.m. to 8 p.m. due to traffic. What is wrong with these planners? Why do they not think about the people from Donegal and Mayo who must bring their sick children into Dublin? Some of them do not know Dublin and some of them will not get parking outside the hospital. I do not wish to get involved in this row. However, they should be more reasonable and look around for an alternative site. Why does everything have to be located in Dublin? Why can we not take the hospital outside the city so people can drive to it from all over the country? Sick people will be coming to this national hospital from all over the country. Why do we not try to make it easy for them? I am not getting involved in the row over whether it is right or wrong or whether we should have one hospital or three. The only row in which I am getting involved is in respect of the site and location of the hospital. It does not make economic sense to bring people from Westport and Belmullet to the Mater Hospital when one cannot get up or down the streets due to traffic, cannot get parking and when people who do not know the city will have sick children with them. Traffic wardens and clampers will clamp these people's cars with sick children inside. It is time a bit of sense prevailed and that people started thinking about each other rather than themselves.

People are very worried about the proposal by the Minister for Health and Children in respect of long-term care. The Minister and Government should reassure people, particularly elderly people, who are frightened and feel nobody is listening to them.

I previously raised another issue with the Minister of State who wrote back to me, for which I give him credit. He investigated the matter and did his best, but the issue will not go away. It concerns the savage attack, a word I wish to put on the record, on the elderly in Roscommon, Galway and, in particular, Mayo where the State will not even help a person on social welfare to go to his or her hospital appointments. People are cancelling vital hospital appointments because they cannot afford to travel to them. This is the same HSE which brought its staff down to a big hotel and spent thousands of euro on wining and dining them while they talked about the HSE, its services and the job they are doing. I am sure they clapped each other on the back at 2 a.m. after having their lovely dinner in their lovely hotel.

The Minister knows about the case to which I am referring because I sent details of it to him. The person had undergone a heart transplant and other major surgery in the past but could not be brought from north Mayo to the hospital appointment in Dublin. Elderly people receiving pensions of over €200 per week, formerly €178 per week, cannot be brought to hospitals in Sligo and Galway. It would cost them €200 to get a taxi from Belmullet to Galway or Dublin. If we are serious about health and the elderly, the Minister of State and his Department must act because they will face another scandal. Someone will take this matter to the Four Courts and we will again be paying back money to people and rightly so. It is a sad day when people have to go to court to get their rights when Ministers and the Government will not provide them.

If someone on a low income is sick and needs an ambulance or assistance from the HSE western area, this should be put in place. They should not be affected because of inefficient people who are unable to run the transport service and have let it run over budget over the last number of years. My blood boiled when I read a newspaper report last week which I believe concerned WestDoc. I read about them buying a fleet of new vehicles for the services. I have the photograph because I intend to raise it on the Adjournment. I tabled a parliamentary question about how much these vehicles cost and experienced great difficulty in getting an answer. Vehicles and jobs for retired people are more important than people needing transport. Some people are leaving the public service, getting jobs with WestDoc and driving beautiful vehicles. When one of my constituents was dying on the floor the other night, the only questions that could be asked over the telephone were what his age and condition were. This is not the kind of health service we want. If we are serious about health and the elderly, we should be out there providing the service for them.

Has my time concluded?

Séamus Pattison (Carlow-Kilkenny, Labour)
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Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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It is time we put people, rather than health service officials, first. I see it in my county and region. I did not see much change, but I did see one change. I saw more people getting more jobs at better salaries, more pencil pushers and less work for people.

Photo of Cecilia KeaveneyCecilia Keaveney (Donegal North East, Fianna Fail)
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I am sad we have reached a day where we must bring in a Bill that deals with inspections of nursing homes. Of course, everybody needs to be brought up to important standards which need to be maintained. I suppose it is the background to the Bill, where some people have been exposed to treatment they should not have been exposed to, that makes me sad. We all have an interest in this because none of us is getting younger. It is always said that one should look after one's children and grandchildren because they will choose one's nursing home. In this context, the Bill is relevant to everybody in the House and I am glad it has had such a long airing on Second Stage.

No one can stand over those tragic situations where, for whatever reason, people felt they could treat older people with anything less than respect and dignity. It might be naive to say so, but I am confident in saying that in my constituency people still put a very high value on the level of care for the elderly. I like to think that when the inspection teams visit institutions in my constituency, they will pass with flying colours. I like to think that humanity in Ireland has not sunk so far and that the cases highlighted are far from the norm.

Having said that, I was recently asked what I thought about on-farm cross-compliance inspections, which led me to think about how in nearly every walk of life, be it in education in schools or farming, there are established inspection services. When one is talking about the most vulnerable people, namely, sick elderly people, there is no need to explain why they should be embraced by an inspection process.

This Bill deals with foster care and private and public nursing homes. I like to think the audits that have begun, namely, the hygiene audits in public and, I assume, private hospitals, will also get a focus, although possibly not under this Bill. I hope these audits will always remain independent and that people will continue to ensure we always strive to achieve the highest form of cleanliness, not only in our nursing homes and those types of institutions, but also in our hospitals because we know the impact of MRSA. A group in Donegal is working very hard to continue lobbying people so they are aware that when they visit hospitals they are potentially bringing in bacteria or their actions can spread bacteria. We all have a role to play in letting people know that our actions and inaction in terms of simple matters like washing our hands can have a big impact on people who are already vulnerable because of the illnesses they have in our hospitals.

There has been much investment in hospitals. In my area, Letterkenny General Hospital is moving from innovation to innovation. It has been under a certain amount of pressure, but I am glad that in terms of beds, a 30-bed modular unit is ready to roll in March and the bigger project has gone through planning. I am glad to see this happening because there have been pressures there but the nursing staff in particular have been coping and deserve the easing of this pressure.

I am also glad there has again been confirmation this week that the Government has moved in respect of the permanent breast surgeon who will be based in Letterkenny. It is part of the overall striving to ensure that when people are in hospital, they are treated to the best possible level and, particularly in respect of breast cancer, can have their surgery in a safe local environment. I do not believe we should just have a local service. The service should be of the highest value to the patient because one does not want to have any old level of service provided locally. Ultimately, if one is sick, one wants the best possible chance of survival.

The task of finding a partner for Letterkenny General Hospital was slow and arduous. The choice of University College Hospital Galway has led to new and important opportunities. I am pleased to see BreastCheck is still on target for the end of 2007. I also look forward to the development of the satellite service, whether it is out of Belfast or Galway. I welcome the fact that patients from Donegal with breast surgery issues have three choices, in Belfast, Galway and Dublin. It is an indication that things have moved on. Progress is evident also in the extension of the NowDoc service as a cross-Border one. This is an indication of the ongoing improvement in cross-Border co-operation. For example, there is co-operation on ENT and dermatology services between Letterkenny and Altnagelvin hospitals.

Cross-Border co-operation makes sense. The current level of co-operation could result in patients going to nursing homes in another jurisdiction, depending on their location. I would welcome an indication of whether talks are ongoing between the HSE and its equivalent in the Six Counties to ensure some level of integration between the two services so that reports and inspections can be carried out on a north-west region basis rather than a North-South basis.

I referred to the extra beds, services and supports being provided for such hospitals as Letterkenny and the need for hygiene audits to continue and be independent. Patients and visitors alike must be made aware of the role they have to play in continuing to ensure they do not spread germs when they go into hospitals in Letterkenny, Buncrana and Carndonagh.

People who are ill prefer to be at home if that is possible. I welcome the Bill in that context. A number of people have offered their homes to look after elderly people. In the main these are high quality locations for patients but it is important for them to be checked because support may be required for people in terms of home care packages either in the patient's own home or this type of half-way house and it is important that inspectors would be able to pick up on this at first hand as well as be in a position to suggest the use of best practice models from elsewhere.

The home care packages provided by the Minister, Deputy Harney, are only beginning to take effect and there is still a long way to go in this regard. In my constituency the district hospital tends to hold on to patients for a long time. In many cases, families would prefer their relative to be in the district hospital than for them to move home or to a nursing home. As a result, nursing homes are not as prevalent in some rural areas as in other places because district hospitals are still seen as step-down facilities and many people continue to remain there even when the medical need is less acute and could possibly be dealt with elsewhere. That said, district hospitals provide an important service. The provision of adequate home care packages are the best way to ensure the step-down from district hospitals into the community.

Voluntary housing schemes have delivered many housing units in rural areas. A number of them operate in my constituency. These schemes primarily cater for elderly people. They are not nursing homes. They provide a home from home for elderly people. While capital funding is provided, these schemes also need social capital. We should focus on the personnel involved. Such homes are not registered as nursing homes. They are voluntary housing schemes for elderly people provided under the aegis of the Department of the Environment, Heritage and Local Government. Education may be necessary for staff working in these homes with the elderly. Public nursing care is another aspect that must be considered. I would not advocate that such centres would be registered as nursing homes; I would prefer the focus to be on the provision of home care packages, which provide a home environment for people who can no longer live at home. The Department of the Environment, Heritage and Local Government and the HSE should link up on this matter.

The Alzheimer's unit in Carndonagh will be of great benefit to the community as it will provide help for families who have difficulty dealing with patients but it will also offer advice and a listening ear service for families who do not wish to institutionalise their relatives.

I wish to refer to the sad death featured on the front page of many newspapers today — Deputy Deasy referred to this case earlier. We are very saddened any time a young person loses his or her life. Having read the HSE statement, it is clear Deputy Deasy and the HSE place a different emphasis on what happened and, more importantly, what should have happened. Professionals within agencies, be it the HSE, the Garda Síochána or the justice system, make decisions based on recommendations. Every case is individual and the circumstances are specific to each one. I read that in this instance the HSE confirmed that residential care was not ruled out.

All professionals agree, whether in terms of young people or the elderly, that people do best when they remain at home. If young people are at home with parents they have the best chance of recovery. If that is not possible, the next best option is to be in another home in a family environment or similar. Of the 5,000 children in care in Ireland, 90% are currently in foster care. In the case highlighted today it is important that we await the results of the review when it is completed, pass judgment at that point and learn from any mistakes that may have been made. I do not wish to pre-empt the outcome of the review. Great people in my constituency have taken on foster children, some of whom can be quite difficult. I welcome the Government's continued recognition of the valuable work done by these families and the increase in the support mechanisms provided for them. We should never forget the invaluable work done by people who become foster carers.

I also welcome the budget increase in nursing home subventions. There are a number of public and private nursing homes in my area. It was a big shock when one of them increased its rates by €250 per week recently. When I hear of the charges for nursing homes in Dublin and elsewhere I wonder how nursing homes in Donegal survive on what they charge. The increase in subvention has enabled the nursing home in question to increase its charges, which had not been increased in five years. I do not know how they have survived. In the north west people have tried to keep family members at home for longer and by the time they get to nursing homes they are much older. The average age at which they enter nursing homes in my area is 80 plus and, therefore, they have greater medical needs. I congratulate those who have been able to keep people at home and I know people want to remain at home. This Bill is about ensuring that when they are at home there will be inspections and that they will be looked after properly and that if they have to go into a nursing home they will receive appropriate and proper care.

I have already referred to the support for district hospitals because I believe the nurses there do tremendous work. While there is a dispute concerning the 39 hour and the 35 hour week I hope it can be resolved through dialogue and without resorting to industrial action. In our communities we all know the nurses and the last thing one wants is industrial action. I hope the ongoing talks will result in a successful conclusion.

I want to include a spoke for my report on music therapy which I published in September. We are speaking about extra care in nursing homes and trying to ensure people's quality of life is maintained. From the perspective of mental health, there was a major debate in the media yesterday and today on A Vision for Change and on introducing new creative therapies into the multi-disciplinary approach to mental health. In my report I prove that music therapy must be central to that multi-disciplinary approach, yet we have not defined it as a profession and, therefore, it cannot be paid for as a professional grade. I ask the Minister, the Minister of State and the HSE to continue to try to have music therapists recognised, as they are everywhere else, including Northern Ireland, on a par with physiotherapists, occupational therapists and speech therapists. There is no point in us touching our cap to A Vision for Change and saying we want multi-disciplinary approaches when one of its most effective aspects, the creative therapies, is being ignored. I will continue this battle until it happens as I have got to the stage where I really believe in it. The proof is all around us.

Whether one is young and autistic or has suffered a trauma and cannot or will not speak, is a parent of a toddler with whom one has not bonded, an Alzheimer's patient or an elderly person with communication difficulties, music therapy has a role to play. That is central to the people we are talking about, those who want a better quality of life and want the Government to intervene in the provision of new and creative approaches to improve their quality of life. That is not unique to Europe but is central to many European countries' provision of care.

Much has been said recently about rural access to pubs. Rural people want not only access to pubs but to be able to collect their pension and go shopping and on hospital visits, but in many cases there is no rural transport. That the EU has sanctioned the pilot rural transport initiative as a national transport service is welcome. The issue of access to hospitals should be central to any discussion on the rural transport initiative. Ultimately Action Inishowen and the wheelchair bus from the disability sector in Inishowen is providing a service for patients. It is important to realise that rural transport should not begin and end at the pub and it should not be the central focus of rural transport because there is much more to rural life than going to and from pubs.

The message about the National Treatment Purchase Fund is not getting out. People still say they have been told of a waiting list of a year or 18 months for hip and knee operations. I do not know how the HSE can get the message out any clearer but if people have a medical need perhaps this is an area in which the inspectorate has a role. Given that one can self-refer or the general practitioner can refer a person to the National Treatment Purchase Fund, it is important that message is got out through the media and general practitioners. I am concerned that, many months later, people still believe there is more than a three-month waiting list for operations. The Government has been proactive in this area and has been successful.

I wish the Bill well. I hope it is a matter of saying, "well done, good and faithful servants", to those whom people visit, but I realise the Bill is needed at this time to ensure there are quality standards for everyone in this House as we get older.

Gay Mitchell (Dublin South Central, Fine Gael)
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I wish to say a few words about accountability and transparency. I wish to speak first about occupational therapy assessments for older people who need not be institutionalised and could well be at home and have a comfortable life there if simple fittings, such as stair rails and bath rails, were installed. However, many people cannot get assistance to have these fittings installed, at least in Dublin, because of the three-year waiting list to see an occupational therapist. This is crazy. Something has to be done to clear that arrears list.

General practitioners should be allowed certify that such fittings are necessary and urgent and should be installed or there should be some process whereby one can purchase privately an occupational therapists' report, or some such method. This Stalinist economic control system cannot continue.

I am aware occupational therapists do not like me raising this issue and they think I am a terrible man for doing so. One occupational therapist manager wrote to me recently saying nothing could be done on a case that needed special and urgent attention because everybody had to be dealt with in order. That is not what happens in local authorities. Where there is a particular urgency, the services of an occupational therapist is brought in to allow something urgent to be done outside of the norm. What the person who wrote to me does not know is that I know her name is on the list for the local authority and that she does the nixer for the local authority. Yet she has told me that those in the Health Service Executive have to wait on the list and that this is an important principle. The principle is that while we continue to operate this system old people are falling down stairs.

A lady in Inchicore fell down the stairs and ended up in hospital. She is in need of a wheelchair because she had to wait for assessment for occupational therapy to have a few rails installed. This is not all about institutional issues. There are ways and means of keeping people out of institutions if we put our minds to it. It is time we looked at these lists. A three-year waiting list for assessment for occupational therapy is not acceptable. Neither is it acceptable that occupational therapists should be the people in charge of assessing whether this is a fair and reasonable system.

I have heard much about representations made by Deputies. We live in a democracy. Nobody has any money to spend on public services aside from what this House takes from the people's pockets, under the authority they have given us and which we in turn entrust to Government authorities and agencies. Like the Minister, I vote in this House annually to take that money from the people and to provide it for these services.

I speak on behalf of the shareholder or the owner of these organisations and I am entitled to question a three year waiting list for occupational therapy. Why is it that when there is an exceptional case there is no compassionate system for dealing with it? Why must it all end up in some sort of institutional arrangement and huge waiting lists? That is unacceptable. What is wrong is that there is no accountability. This would not be accepted in the private sector. This system is not operated in local authorities because there is compassion and interaction between public representatives and officials, who can arrive at real solutions to immediate problems. It is true that some people are left to wait, but they are the people who are capable of waiting. If somebody turns up with an urgent problem, that urgency should be addressed.

The Minister and I, as public representatives, know there are always exceptional cases. Over the years I have found that any rigid rules we made always left hard cases on the wrong side of the line. When I asked people why such things happened they would reply: "Deputy or councillor, you made the rules." It was better to have some discretion left to public officials, even if it was open to abuse, than to have people suffering injustice as a result of being left on the wrong side of the line. I urge the Minister to take this issue on board and to examine why people are waiting so long for occupational therapy and why there is an absence of accountability and transparency.

The Bill seeks to address this in certain ways. However, I can give another example of the absence of accountability and transparency. It is the issue of the location of the new children's hospital. I represent a constituency that includes the Crumlin area and I am a former member of the committee of management of the board of the hospital. Of course, I want the hospital to remain where it is. I have an emotional attachment to it, like everybody else in the locality. However, I took the remit of the task force seriously. I consulted people, went to look at possible sites and met with members of the task force. I do not know if any other Deputy from Dublin South-Central did that; I doubt it.

When I met the task force my first direct question was whether the decision had already been made to locate the hospital at the Mater Hospital site. The reply was that this was certainly not the case, that the task force had an open mind and that it could be sited at any hospital in Dublin that applied. There were certain issues involved with regard to locating it with an adult teaching hospital. On that basis, I spoke to the task force about the project. I said I would like the hospital to remain on the Crumlin site but I also said something that probably no other Deputy had said, that I was prepared to see a hospital in my constituency moved if it was in the interests of children. However, if the task force was considering moving the hospital, I asked it to explain why it would be moved away from the M50.

Let us examine the site of Our Lady's Hospital for Sick Children in Crumlin. An application for planning permission was made by senior consultants, including from the Mater Hospital, to locate a private consultancy facility on that site. The reason is that it is so easy to access from the M50. It could be accessed from any part of Dublin and any part of the country. They wanted to locate this facility beside the children's hospital. The only reason it did not go ahead was that the planning application was unsuccessful.

Down the road are two hospitals which are also accessible from the M50, St. James's Hospital and the Coombe Hospital. The Coombe Hospital is adjacent to St. Teresa's Gardens, which is about to be knocked down, and the old Player Wills site which is due to be redeveloped. This was a golden opportunity to redevelop the children's hospital near a women's hospital, as had occurred with two facilities in Canada according to the preliminary report. Would that not be an ideal location for a children's hospital?

What about across the road in St. James's Hospital, which is joined at the hip, so to speak, to the Coombe Hospital? St. James's Hospital is on an enormous site; I believe it is approximately 24 hectares. The site at the Mater Hospital is approximately six hectares. I am not definite about the figures but they are of that order. The Luas line runs through St. James's Hospital. The hospital is a five minute walk from the Coombe Hospital. The Luas line goes to Heuston Station and Connolly Station and, therefore, connects with the DART. This hospital is connected to the DART, Connolly Station and Heuston Station and is near the M50. It is a teaching hospital on a huge site.

According to the task force the choice came down to the Mater Hospital and St. James's Hospital. The task force never said that the Mater was the better site but that the hospital would probably be built quicker there. After the event, Dr. Drumm said that the metro would go to the Mater Hospital. However, the decision on the metro was not made until after the decision on the hospital. On the day that an editorial appeared in The Irish Times stating that the decision had been made and we should proceed with it, I rang the editor's office. I had never done this previously. I told the office that the editorial was a load of nonsense and that the newspaper should be examining how this decision was made. I did that on the day of the women's marathon; I am not sure what date it was.

I do not easily ring up the editor's office in The Irish Times. I have a great deal of time for the editor and for the newspaper's general policy of openness. Now, however, I believe investigative journalism is this country has gone to sleep with regard to this decision making process. How did we arrive at deciding on the Mater Hospital site for a national children's hospital? If there was an international, independent review of this decision and it arrived at the conclusion that the Mater Hospital is the correct site, I would shut up and say nothing more about it. However, I do not believe this was the best decision in the interests of children. I cannot understand how the Mater Hospital site was selected in a choice between it and St. James's Hospital.

One of the reasons given is that the hospital can be built quickly. What is the hurry? Why must it be built quickly? This hospital will supposedly be in existence for a couple of hundred years. Is it necessary to build a hospital that is not the best simply to have it built a few months earlier? Is that the right thing to do? I do not believe so.

I also rang "Morning Ireland" on the morning the decision was announced. A doctor from Temple Street Hospital was on the programme. I told the programme makers that the decision did not stand up. RTE returned to the issue on the "News at One" but this time the bold Dr. Drumm was on the radio to explain why it was such a wonderful decision. I am sure Dr. Drumm is a very good paediatrician and I hope he is a good chief executive, but he is not a politician. The late Judge Sean O'Leary criticised his colleagues in the Judiciary for intruding into the area of politics. I must also criticise Dr. Drumm; I believe he has crossed the line and entered the political arena.

The person who should explain this issue is the Minister for Health and Children. That is what she is elected, appointed and paid to do, not to put a doctor forward to explain it. No paediatrician was involved in the decision to locate this hospital. It is an extraordinary lapse. Furthermore, my colleague, Senator Brian Hayes, discovered from an Adjournment debate in the Seanad that no point scoring system was used to assess this decision, as was used for other projects. How was this decision arrived at? Where is the accountability and transparency if such decisions cannot be explained to the House?

We simply have the Minister for Health and Children stating that the decision is made. She wants to be seen to be the hard woman backing the Taoiseach, saying the PDs will not let Fianna Fáil down, and having done a deal for Government will stick by it. That is not what this is about. This about the health of children. It is not about politicians or votes or doctors. It is about children. What is the problem with taking a couple of months to have somebody examine this case and saying to everybody beforehand that whatever the outcome of the independent assessment that will be the basis on which the decision will be made, regardless of what politicians or doctors say, and that it will be accepted? If it is confirmed that the Mater Hospital site should be used, let us get on with it and have no further delay. In the interests of transparency, the decision should be reviewed internationally.

It may be a coincidence that the Taoiseach is a former employee of the Mater Hospital. It may be a coincidence that, as one doctor stated, he is invited to the Mater Hospital to unveil every pane of glass that is put in. It may be a coincidence that the hospital is in the Taoiseach's constituency. Perhaps I am being unfair to him in raising this. However, in the interests of children and in the interests of the people who elected me to this House, it is reasonable for me to raise it. The Taoiseach, described by the late Taoiseach, Charles Haughey, as the most cunning, the most devious of them all, will not leave his fingerprints on this.

Let us put all suspicions to one side. Let the Minister for Health and Children, Deputy Harney, who told us the PDs were in Government to guard against the excesses of Fianna Fáil, stand back from this and say this is not a case of local pleading but a case where people's genuine concerns need to be addressed and that this can be done in a short time. I have no interest in getting involved in medical politics. I repeat that if the children's hospital is to move from the Crumlin site to a better site in the interests of children I am prepared to accept that as well. However, I do not accept that I should be patted on the head by a task force and a chief executive of a HSE who have made the decision because they believe they know best. I have been elected every 23 months for 26 years. I have been a member of local authorities. I have been a Member of this House and of the European Parliament. I know a bit about how public services work and I accept that the public service running our Health Service Executive and the Department of Health and Children is open, accountable and transparent. However, I believe the way this decision was made leaves much to be desired.

It is time Members of this House stood up for their right and duty to make their views known. That is why we were sent here. People who have not been elected to this House should not involve themselves in politics or act as a mouthpiece for the Minister. I suspect, and I say this with some sadness, that the reason some people do not want an independent review is that if it is found the Mater Hospital is not the right location their position will become untenable because they have put themselves out on a limb, and that is not the right place for public servants to be. Ministers are elected to be accountable, to go on radio and television and to appear in this House to answer questions. Ministers should take that responsibility. That is part of the whole business of accountability and transparency.

As spokesman on health I regularly raised with the then Minister, Deputy Martin, issues related to the number of committees, groups, inquiries, task forces and so on created by the Department. I asked by way of parliamentary question how many there were. There were so many that an answer could not be given immediately. It took some weeks to compile a list of approximately 160 different groups. In all of those groups there are administrators, doctors, unions, nurses and, in some cases, patients, but they are only one among many. All of these are dividing up the cake and what is left goes to patients. If the Government doubled the amount of spending on health tomorrow the system would gobble it up. Somebody needs to take a step back and put the patient back at the top of the list. The patient should be first. I published a Private Members' Bill, the aim of which was to create the office of surgeon general, not another quango to report to the Government but somebody to report directly to Dáil Éireann through the Committee on Health and Children. The role of surgeon general would be similar to the role played by the Comptroller and Auditor General in the area of general public expenditure. The strength of the Comptroller and Auditor General is that he is totally independent and reports directly to Dáil Éireann, working with the Dáil through the Committee of Public Accounts. Until we have a powerful advocate, with the title of surgeon general or some other title, who reports to Dáil Éireann, Members of the Dáil who provide all the money for the health services will be throwing good money after bad because the system is not being reformed or changed in any way.

How can anybody deal on radio or television with the emotive language of doctors, nurses or parents who have sick children, who want to praise what exists and not disturb it? We need to disturb it. The system cannot continue as it is. We need to appoint somebody to become a powerful advocate for patients, who will cut through all the self interest that exists in the health service and who will report directly to the Dáil. I would give that person the title of surgeon general. Even if the office were abolished after five years it would help. That person appointed would work directly with the Dáil through the Committee on Health and Children and would put the patient first, which is not happening in the health service at the moment.

2:00 pm

Photo of Joe CostelloJoe Costello (Dublin Central, Labour)
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I am delighted to have the opportunity to say a few words on this Bill. Listening to Deputy Gay Mitchell, it is obvious the issue of the children's hospital is very much alive. I have a view on the matter that is diametrically opposed to Deputy Mitchell's. I speak with some experience. I was chairman of the save Temple Street Children's Hospital campaign more than a quarter of a century ago, before becoming involved in politics. Over the years I have watched the building deteriorate, despite the wonderful service provided by the nurses and the staff. I have watched the failure of successive Governments to deliver on the Temple Street Children's Hospital on the Mater Hospital site as was proposed at the time. I remember bringing the former leader of the Labour Party, Mr. Dick Spring, into the hospital in 1977 to see the conditions and he made an absolute commitment that if returned to Government Labour would build the hospital.

It is an absolute disgrace that Temple Street Children's Hospital has not been rebuilt on that site long before now. Rather than accusing the Taoiseach of putting his oar in in regard to getting the final decision on the national hospital, I would accuse him of flagrant negligence in the past ten years in not getting Temple Street Children's Hospital up and running. In 2000, €400 million was put aside in the national development plan for the project, yet at the 11th hour, on 29 December 2005, after planning permission had been granted and the tenders had been submitted, the Mater Hospital and Temple Street Children's Hospital were instructed not to open the tenders because McKinsey consultants was being appointed to look into the optimum type of structure for a children's hospital. It was not at the 11th hour but at the last second before midnight, with everything already prepared. It would be difficult to imagine this happening in a properly organised system. This looked once more like another hoop which Temple Street had to go through. The report then changed terms and recommended a national hospital rather than putting Temple Street or any other hospital on the site.

Debate adjourned.