Michael McNamara (Clare, Labour)
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I wish to bring to the Minister of State's attention, if it is indeed necessary to do so, SI 236 of 2009, which provides for minimum standards of health care. It goes without saying that the standards contained in the statutory instrument are to be welcomed and are desirable. The statutory instrument reads: "The registered provider shall not use premises for the purposes of a designated centre unless the premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose". The statement of purpose, contained at paragraph 10, reads:

The registered provider shall ensure that residents are provided with:...

(c) privacy, insofar as is reasonably practicable, to the extent that the resident is able to undertake personal activities in private;

Within six years of implementation of the standards, there are to be no more than two residents per room, except in high-dependency rooms, which shall have up to six highly dependent residents.

Since getting elected I have spent time visiting the State facilities for community care across County Clare. There are three facilities, in Raheen Hospital, Stella Maris and Ennistymon. I spent a lot of time in St. Joseph’s Hospital in Ennis for personal reasons. I express my thanks to the staff of St. Joseph’s for the excellent standard of care which they provide. I am pleased to say the standard of care was vindicated in a recent HIQA investigation in St. Joseph’s at the end of 2012. An inspection was carried out on 27 and 28 November. However, the fact that St. Joseph’s, like the great majority of such facilities across the country, is a relatively old establishment, unsurprisingly, it was found not to comply with the standard of having only two residents per room.

While I was there I took the opportunity to discuss the issue with residents. A close relative of mine who was there likewise, discussed matters with her fellow residents. There is not unanimity among residents on the facilities. Not all of them would like to be in single rooms or rooms of two people. In many instances, people prefer to be in larger rooms. That is not to say the standard should be lowered in any way or that people do not want their privacy to be respected. Of course they do. However, to extrapolate from respecting privacy to putting people in single and double rooms exclusively is questionable. I question whether it is feasible. It has been acknowledged by the HSE that there would be great difficulty in bringing St. Joseph’s into line with the requirement of single and double rooms. Likewise, with the facilities in Kilrush and Raheen, and to a slightly lesser extent in Ennistymon. I speak of County Clare but I am sure the situation is mirrored across the country.

I do not for a moment wish to appear to advocate a lower standard for residents in such institutions. That is not the case at all. However, I wonder about the extent to which the views of residents have been canvassed and their opinions sought when it was determined that it was in their best interests to be in single rooms. Many people would love to get out of private facilities where they have single rooms and to get into public facilities where they share rooms and have companionship, regardless of the reason they are in the facilities.

A second issue to which I would like to bring to the attention of the Minister of State is the manner in which the inspections are carried out. I refer to a facility that is not in my constituency; it is in the constituency of the Leas-Cheann Comhairle, namely, St. Anne’s in Woodford on the Clare and Galway border. A follow-up inspection was carried out on 19 October 2011 and, by and large, it was unfavourable. Fire hazards were not raised at all. In February 2012 a further inspection was carried out and the facility was closed within 24 hours. I do not understand how no issue relating to fire hazard could arise in October 2011 yet the following February the facility was to be closed within 24 hours, which created considerable difficulty for many elderly residents who had to be moved. Some of them had spent a long period of time there and the nature of their departure created much turmoil for them and their families. Nobody from HIQA was prepared to meet with any of the relatives to explain how the closure came about. There seems to be no redress.

Alex White (Dublin South, Labour)
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I thank Deputy McNamara for raising the issue and for his insights and observations on it. I will make some general remarks at the outset.

The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible and to support access to quality, long-term residential care where that is appropriate. If it becomes necessary for an older person to move to a nursing home, their safety and well-being is of paramount concern. We must ensure that the highest standards of care are provided to all residents in a safe and secure environment, and that we meet the needs of those who require our services in the very best way possible.

The Health Information and Quality Authority, HIQA, is the independent body responsible for promoting quality and safety in the provision of health and personal social services for the benefit of service users. On 1 July 2009 statutory responsibility for inspecting and registering nursing homes was given to HIQA's chief inspector of social services. That is underpinned by a comprehensive quality framework comprising the Health Act 2007, Care and Welfare Regulations and the National Quality Standards for Residential Care Settings for Older People in Ireland. Members will agree that it is important to have effective mechanisms to maintain and enhance public confidence in the delivery of quality residential care. Residents, their families and the public need to be reassured that the care people receive is monitored. The Health Act 2007 provides that, with a regime designed to protect the public through an independent inspection and registration system for residential services.

Patient safety and quality assurance in nursing homes is secured by setting quality standards, reinforced by regulations that specify how the best service possible can be delivered in an effective and appropriate way. The national quality standards to which the Deputy refers are an essential component in ensuring the quality and safety of residential care for the older population. There are 32 standards under seven groupings: rights, protection, health and social needs, quality of life, staffing, the care environment and governance and management. They are patient-centred, providing a blueprint for the provision of a higher standard of care delivered against a set of clear and comprehensive criteria. In summary, the standards promote health, well-being and quality of life, and older people are entitled to their effective implementation and monitoring and for effective steps to be taken if they are not met.

All nursing homes for older people, whether public, private or voluntary, are subject to the same core standards for quality and safety. As Deputy McNamara indicated, HIQA carries out inspections across the nursing home sector to ensure that the standards are being met and that residents are receiving the best possible care.

I expect we would all agree that lessons had to be learned from some very unsatisfactory and well-publicised incidents in nursing homes in recent years and from reports such as that of the Leas Cross commission of investigation. Our system of regulation and inspection was established for the sole purpose of ensuring safety and quality of care for nursing home residents. While standards of care are, thankfully, generally very good, we cannot and must not be complacent when it comes to the protection of older people.

The Deputy raised a query on one of the categories of requirement concerning nursing homes. It is an interesting point, in particular on the extent to which there was consultation with older people themselves in respect of the standards. Deputy McNamara would agree that we can only operate on the basis of standards that are put together in a rational way. They cannot be nursing home-specific or area-specific; the standards must be national in order for them to be understood and properly monitored.

As the Deputy is aware, the current standards were approved in 2009. They were developed by a working group that was chaired by HIQA, which importantly comprised the regulator, service providers of private, voluntary and HSE nursing homes, older people's advocacy groups, people involved in the care and treatment of older people and the Department. There was an important and, as the Deputy indicated, necessary, input on behalf of persons directly affected, in particular the active and effective advocacy groups for older people who operate in this country. I reassure the Deputy and the House that such groups who are engaged in the issue were consulted. It is important that they should be. There is no harm in there being continuing debate on the issue but I reassure the Deputy and the House that it is something that was taken carefully into account when the standards were being put in place.

Michael McNamara (Clare, Labour)
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I thank the Minister of State for his reply. There was not a sentence in it with which I could possibly disagree. We all agree that we want to have the highest possible standards of care across the health system, but especially for elderly people who contributed to the State, built it up and frequently created excellent facilities from what were work houses across County Clare and turned them into care facilities of which any country could be proud. The standard of care provided there is second to none.

I know anecdotally, although the Minister of State will not be particularly interested in anecdotal evidence, that treatment is frequently better in public facilities than in private facilities, hence the huge queue for treatment in public facilities.

On the issue of patient-centred standards, if one were to take a survey of patients in care, I wonder whether they would want to be in single rooms or prefer to be in rooms accommodating four, five or even six patients. I wonder when the time period applying to these standards runs out, as it inevitably will, whether a detailed survey on that issue will be carried out. I accept these points are based on my observations and are anecdotal as opposed to being based on statistics and rational evidence and that it does not meet any of the tests, but from what I have seen, I think many people would prefer to be in communal rooms.

It is important that we have an independent body but it is also important that an independent body is not beyond reproach or certainly not beyond accountability. Efforts by families members of patients moved from St. Anne's to get in contact with HIQA were singularly unsuccessful. I do not blame HIQA for that because it believes that to safeguard its independence it cannot engage in a dialogue, but there must be some mechanism by which people who feel aggrieved or feel there is a discrepancy between two reports can have their concerns addressed.

Inspections are important but they must be carried out uniformly. There is not a uniformity apparent to me with regard to these two reports. I appreciate I am bringing up these specifics to the Minister of State for the first time and that HIQA is independent and therefore there is very little that he can do. I urge HIQA to examine the uniformity of its inspections and also to examine how it deals with relatives of patients who are unhappy with the results of the inspections, even if they were carried out in the very best interests of the patients.

Alex White (Dublin South, Labour)
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The Deputy would not expect me to comment on or refer to any of the individual inspections to which he has pointed, but I repeat the comment and observation on how the particular standards play out in particular nursing homes. I take the Deputy's point, that it may not always be immediately clear to us if we walk into a nursing home that the standards are wholly appropriate when we view a particular human situation, but I think we can be sure and reassured that the standards did not come from nowhere, that the standards were put together on a rational basis, that they make sense, that people were consulted on them and that nothing is set in stone. I have taken careful note of what the Deputy said. I am sure there is a mechanism to provide for a review - I do not have it immediately to hand - but I am sure that a review is contemplated in all of these kinds of standards. It may well be that in the future the kinds of insights that the Deputy has raised could be taken into account.