Fergus O'Dowd (Louth, Fine Gael)
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I welcome the presence of the Minister for Health. I wish to speak about a report on the HIQA website on the inspection of homes for the elderly. I praise HIQA for the tremendous commitment and dedication of its staff who always work, as they must, within the law. In the year about which I am speaking, more than 500 individual investigations into various homes were conducted with regard to inspection reports. A serious legal anomaly has arisen, as more than 350 written or verbal complaints were received by HIQA relating to more than 213 homes, but none of them could be investigated directly by HIQA because the law does not allow it to do so. The list of issues raised in these complaints includes elder abuse, financial abuse, verbal, physical and sexual abuse of residents, dementia patients with fractured ribs, patients being unwashed, a 90 year old patient freezing cold, broken furniture and, specifically, reference is made to a number of deaths from septicaemia and at least seven other deaths. At present, HIQA cannot investigate these.

I will give a sample of some of the individual complaints. A resident died due to staff not being trained properly and poor quality of care. A doctor called did not visit the actual patient. Another doctor stated the patient had a slight chest infection, but on arrival at hospital the person had severe pneumonia and dehydration and died. Forms were updated in the office by three members of staff after the admission to hospital.

A male patient was calling for help with two bare legs over his bed rails. After ten minutes a staff member closed the door on him and did not help. The poor man died with unexplained marks on his hand.

In another home a resident suffering from Alzheimer's was not looked after properly. No verbal communication took place with her and she was not called by her name. Occasionally she was covered in excrement, on the toilet with a pillow behind her, weak and unable to sit up. She ate meals with excrement on her hands. Although she was vomiting and ill, no ambulance was called. A family member brought her to hospital where she subsequently died.

There are other issues involving unresolved elder abuse and a staff nurse resigned as a result. There has been intimidation of residents. Residents have been left on commodes for four hours or more. There are also cases of residents being scared and in fear. Complaints have not been listened to. Residents have been on commodes at 4.30 a.m. Dementia patients have been given breakfast on commodes.

Professor Des O'Neill, who inquired into the appalling abuse at Leas Cross, found deficient care at many levels.

There was an inadequate number of trained staff and he found that the charge of institutional abuse was proved against Leas Cross. He made two important recommendations - he made 11 in all. The minimum number of staff should be defined nationally and the nursing needs need to be assessed by a nursing needs assessment tool, with which I am sure the Minister is very familiar. On the question of nurses, nurses with qualification in gerontology were absolutely essential to ensure residents of homes were properly and well looked after.

In summary, the charge is that we have failed to change the law enough to allow HIQA to do the excellent job it wants to do. I understand from HIQA that a simple amendment to the Health Act 2007 would allow it to go in and challenge each of these individual complaints. That is the very least we can do to protect our elderly residents in these nursing homes for which they pay an absolute fortune.

Leo Varadkar (Dublin West, Fine Gael)
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I am taking this debate on behalf of the Minister of State, Deputy Kathleen Lynch, who has responsibility for nursing homes. I thank Deputy O'Dowd for raising this matter in the House.

The Health Information and Quality Authority, HIQA, is the independent authority established under the Health Act 2007 to drive continuous improvement and to monitor safety and quality in Ireland's health and personal social care services. Since 2009 all nursing homes - public, voluntary and private have been registered and inspected by HIQA. The Government also extended HIQA's function to residential services for those with disabilities and child-protection services. In addition, we are committed to introducing a regulatory system for home-care services, making them subject to registration and inspection by HIQA, on which work has already commenced.

As regulator, HIQA's remit is to inspect facilities and services rather than investigate individual complaints. Nursing home operators must ensure all reasonable measures are taken to protect residents from all forms of abuse. They must have policies and procedures in place for the prevention and detection of, and the response to abuse. Furthermore, operators must notify HIQA of any allegation of abuse or serious adverse incidents that occur in a nursing home.

All nursing homes are required to have an accessible and effective complaints procedure of their own, including an appeals process. They must investigate all complaints promptly and following investigation, put in place any measures required for improvement. They must keep a record of complaints made, and this record must be available for inspection enabling HIQA when it carries out an inspection to determine whether the nursing home's complaints system is sufficiently robust.

In addition to this, HIQA takes into account and uses all information received, to inform and plan its regulatory activity. Information on individual cases can provide useful pointers in this regard. HIQA's programme of scheduled and unannounced inspections helps to ensure standards are maintained and where issues of non-compliance arise, that these are addressed and rectified. The Department of Health, in consultation with HIQA and service providers, is working to improve and update the requirements that apply to nursing home care.

Lest there be any concerns about this I want to clarify that with public HSE nursing homes, people can make a complaint through the HSE complaint system. If they are not happy with the HSE complaint system, they can go to the Office of the Ombudsman for an independent complaint. Private nursing homes are supposed to have in place their own complaints procedure and to have an appeals mechanism. For both public and private nursing homes a complaint about elder abuse can be made directly to the HSE. The HSE's elder abuse services have 30 senior case-workers who work on exactly that.

HIQA's role is different. Currently HIQA's role is not to deal with individual complaints but to be a regulator and inspectorate. Any change to that role would not be a simple amendment; it would be a major change in the role of that organisation and would require it to be resourced very differently from now in addition to a change in legislation.

Fergus O'Dowd (Louth, Fine Gael)
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I thank the Minister for his reply but I do not accept what he is saying is accurate. HIQA has sought powers from the Oireachtas and from the Department of Health and has addressed the Oireachtas Joint Committee on Health and Children on getting increased powers of inspection, particularly regarding the complaints it receives.

I acknowledge that the Minister's answer is what he has been given. However, the facts are that none of these complaints has been investigated. It is not good enough for anybody to say - I am not personalising this to the Minister - that if a person is not happy he or she can go to the Information Commissioner. Someone who believes his or her relative - who might be dying - has been abused or is being treated appallingly expects HIQA to act. My point is that HIQA wants to act. It wants to do it and is ready to do it. It assures me there is no question of staff complement. There is no issue about qualified staff to go in. However, it has to deal with the issues it finds there. It is the licensing authority for a nursing home. If following a written complaint, including by e-mail, or an oral complaint its inspectors cannot go into that home and see what happened to Johnny Murphy, how Mary Murphy died, what is happening with dementia care or what are the qualifications of staff, we will have a repeat of what happened in Leas Cross.

I appeal to the Minister to listen to what I am saying and to talk to representatives of HIQA. He should read what they said on the record at the Oireachtas committee about the power it needs to protect the elderly. That is a sacred duty for all of us. There can be no avoiding that. There can be no saying, "It's not me; go to somebody else." As I have said there have been more than 352 complaints, many of them about serious issues where people have died. I ask the Minister to reconsider this when he returns to his Department. I intend to continue to pursue this matter. If it means I have to introduce legislation, I will do that to ensure that all these complaints are dealt with immediately and urgently to protect the elderly from abuse. That is our sacred duty.

Leo Varadkar (Dublin West, Fine Gael)
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I clarify once again. If it is a public nursing home, complaints can be made to the HSE, using its complaints procedure or subsequently to the Ombudsman if people are not happy with that. For private nursing homes, complaints have to be made through the private nursing home's own complaints procedure or through the appeals procedure if people are not happy with that. If it is elder abuse, regardless of where it is, complaints can be made to the HSE. It is not the role of HIQA currently to investigate individual complaints.

I must ask whether these complaints have been made through the appropriate channels. Have these complaints been made to the HSE and have these complaints been made to the private nursing homes themselves? I would be concerned if they have not been investigated. However, the fact that they have not been investigated by HIQA, which does not investigate individual complaints, is a very different point from saying they have not been investigated at all. Perhaps the Deputy might clarify that. Is he claiming that they have not been investigated at all or just that they have not been investigated by HIQA, which does not have the authority to investigate individual complaints in the first place?

In my meetings with representatives of HIQA, they have not requested this power. I will check with the Minister of State, Deputy Kathleen Lynch, if they have done so in their meetings with her. If they request it and they can assure me it does not require additional resources and it is willing to take on that existing role from the HSE, from the Ombudsman and from the private nursing homes and the existing appeals procedures, then I am happy to give that full consideration.

Lest anyone thinks otherwise, I want to clarify that the fact that HIQA does not investigate independent individual complaints does not mean they are not investigated. HSE nursing home complaints should go to the HSE and if people are not happy with that, they go to the Ombudsman. When it comes to private nursing homes, every private nursing home has to have its own complaints procedure and appeals procedure in place.