Fergus O'Dowd (Louth, Fine Gael)
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This is an important issue and I thank the Ceann Comhairle for selecting it for debate. I welcome the Minister of State, Deputy Jim Daly, to address it.

Last Thursday week the programme "Prime Time Investigates: Troublemakers" was screened.

It showed how families who care for loved ones in institutional care, be it in a private nursing home or a HSE institution, are denied their natural right to visit their seriously ill family members. Two cases in particular were raised. One was that of Anne Fitzgerald, who is unable to communicate and has been ill and in that medical condition for a long time. Anne's husband Pat and daughter Frances love her greatly and visit her regularly when they are allowed. Pat, who cared so much not just about his wife but also about other people in Cherry Orchard Hospital, made a complaint and expressed concerns about another person who he felt was not being treated properly. As a result, he was barred from visiting his sick wife, as was his daughter. This shameful, disgraceful, arrogant and arbitrary act imposed on Pat and his family is denying to Anne Fitzgerald, the patient who lies in a bed in that hospital, her natural human right to be visited as she wishes by her loved ones. Why was Pat shown on the television programme being allowed to visit his good wife? The reason was that the HSE, in its wisdom, allowed him to visit for one hour four times per week. When the 60 minutes are up, a man knocks on the door and says it is time for him to go. His wife, whom he cares for and loves greatly, is being treated as if she were in jail and is being denied her rights. Pat is being denied his rights, all because he is standing up for other people in a system that is malfunctioning. A recent HIQA report on Cherry Orchard Hospital found nine outcomes of major non-compliance, which is extremely upsetting to all the residents and their families.

It is exceptionally clear to me and, I hope, the country that much more needs to be done to improve standards of care in these institutions. The HSE has been aware for some years of significant shortcomings in the governance, quality and risk management operating in Cherry Orchard Hospital. The shameful and disgraceful treatment of the late David Earls and his family will be the subject of debate here as soon as I can get the facts on three deaths at the hospital, including the death of David. These were investigated and the same outcome in terms of shortcomings in governance, quality and risk management arises.

While I appreciate that the Minister of State is not the administrator of Cherry Orchard Hospital, he is in charge of this area. What I and the family want to see is a proper process of respect for families and an appeals process which they can use if issues arise. Why should Pat not be allowed to visit his wife or Frances her mother in hospital? Anne cannot communicate. No one else will be in that room to see them and for someone to tell them their hour is up is shameful and disgraceful and must end. Since the television programme, no one from the HSE has been in touch with the Fitzgerald family - I rang them just before I came in here - which is absolutely unforgivable. I will be unforgiving and relentless in my pursuit of the management of Cherry Orchard Hospital and the people who make these decisions to ensure these families' absolute right to an appeal.

I will raise the second case in my second contribution.

Jim Daly (Cork South West, Fine Gael)
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Gabhaim buíochas as ucht an deis labhairt ar an ábhar tábhachtach seo. I acknowledge Deputy O'Dowd's long-standing commitment in this area and his fearless dedication and commitment to raising issues and highlighting injustices he has come across in the system.

I understand that the Deputy raises this important issue in the context of a recent "Prime Time" programme which was broadcast, as he said, on 25 October. The care and well-being of the residents is the primary consideration of the person in charge of each residential care centre. The overarching principle is that families play an important role in the care of their loved ones and that visiting should be facilitated in the interest of the resident unless there are compelling reasons this cannot be done. The Health Service Executive does not routinely use visiting restrictions in residential care centres. These settings are now mainly overseen and regulated by the Health Information and Quality Authority, HIQA, or the Mental Health Commission. The inspection reports of both regulatory authorities include the views of residents and their families in many instances.

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. 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 will not be complacent when it comes to the protection of older people and other vulnerable people.

Under current legislation, visiting restrictions may be put in place on occasion for a variety of reasons, including safety concerns relating to infection control and the safeguarding of residents from risk of harm. In respect of older people's settings, both public and private, the registered provider is required to make arrangements for a resident to receive visitors and the person in charge shall ensure that, insofar as is reasonably practicable, visits to a resident are not restricted unless such a visit would, in the opinion of the person in charge, pose a risk to the resident concerned or to another resident, or the resident concerned has requested the restriction of visits. In addition, all nursing homes are required to have an accessible and effective complaints procedure, including an appeals process. They must investigate all complaints promptly and, following investigation, put in place any measures required for improvement.

The provisions of the Mental Health Act 2001 (Approved Centres) Regulations 2006 include a requirement that approved mental health centres take all reasonable steps to ensure the safety of residents and visitors and have written operational policies and procedures on visits and the health and safety of residents, staff and visitors. The HSE currently has 11 instances where visiting to residents is restricted in services for older persons and mental health services. This is in the context of currently providing more than 7,000 such beds across those services. The cases in which restrictions have been put in place are for a variety of reasons, including the residents in question being wards of court, family members holding enduring power of attorney and having requested certain restrictions, and safeguarding concerns. The HSE has advised that each of the current instances where some level of a restriction on visiting is in place will be reviewed. I welcome that decision.

Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister of State's statement and acknowledge that he has been given it to read out. I do not blame him for its content but I do not accept the position in the cases of the Fitzgerald family and the other lady, whom I will call by her first name, Louise. In both these cases the patient is not able to communicate or talk, so there is no question of their not wanting visitors. In both cases there has been arbitrary barring and there is no appeals process. In the case of Louise, her father is dying. When I met her on Sunday she said her father was very seriously ill and would pass away soon. She cannot visit him and was not allowed into the nursing home, which is private, although it is a HSE bed.

There are serious issues here. If the HSE is serious about examining these cases, why has it not contacted the families since Thursday of the week before last? There is an absolutely ruthless disregard of the care and love these families want to show their family members, and it is entirely unacceptable that there is no independent appeals process. Thankfully, there are only 11 such cases. The two cases to which I refer are among them. This is destroying human beings who love and care for their loved ones and cannot show that love in a way that the Minister of State, I or anyone listening to this debate would wish to do. If there is an issue - and I am not talking about these two families - there should be an independent appeals process. It should not involve someone from the HSE or the private nursing home sector. Given that these cases are rare in the first place, as the Minister of State said, appeals should be exceptional. Perhaps a judge or retired judge should look at these cases independently. There should be an appeals process in any case because these families' hearts are broken and the people to whom I talk do not and will not accept that Pat Fitzgerald and his daughter should not be able to visit Anne. That is at the heart of all this. Louise should also have the opportunity to visit her dying father before he passes away.

Jim Daly (Cork South West, Fine Gael)
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I stress to the House that quality care and patient safety must come first. The means of ensuring that all residents receive the same high standard of quality assured care is through adherence to the national standards in this regard.

In recent weeks, the Deputy will be interested to know that the HSE has requested that the chief officers in each community healthcare organisation area to ensure that, in each case where a visiting restriction has been imposed, the chief officer reviews it with the relevant personnel to establish that the measure is warranted, appropriate and to the least level of restriction possible.

Where a restriction has been applied, it should also be ensured that there is an ongoing review that would allow for it to be lifted as soon as the circumstances leading to the decision no longer prevail or are altered. The guiding principle of the maximum inclusion of families must also be upheld, and it should be ensured that consideration of the issue is informed by the most recent regulatory report in respect of each centre, in so far as that report refers to families, families' views, visiting inclusion etc. Where there is a restriction, the families must be offered independent mediation with local HSE staff. I am assured by the HSE that this process is under way.

From a policy perspective, we have taken a number of steps to ensure that the voice of patients is embedded in the health service. It is intended to appoint two patient advocates to the board of the HSE. Proposals for an independent patient safety council are at an advanced stage and we expect to be in a position to bring proposals to the Government very shortly. I am not going to comment on the individual cases. Sometimes cases are highlighted on the television. The Deputy will be the first to acknowledge that there are other cases that do not make it to the television that are equally concerning to us. I will take on board what has been suggested about an independent appeals process.

Fergus O'Dowd (Louth, Fine Gael)
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I ask that the families be contacted by the HSE this evening.

Jim Daly (Cork South West, Fine Gael)
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I will certainly pass that request on to the HSE.