Dáil debates
Thursday, 22 June 2023
Saincheisteanna Tráthúla - Topical Issue Debate
Care of the Elderly
3:25 pm
Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister of State, Deputy Butler, and acknowledge her interest in care of older people. My criticisms are not of the Minister of State personally but of the Government, Government policy, the lack of delivery and the lack of hope for people.
At 3 a.m. on 3 April 2020, a most appalling and evil act was perpetrated upon an elderly lady who was a full-time resident in a nursing home. On 30 July 2020, a court case took place and I welcome the fact that it was speedy and that an appropriate 11-year sentence was handed down to the perpetrator. On 5 August 2020, a few weeks after the court case, HIQA visited the nursing home in question. I am not going to name it because of the sensitivities of other people involved. As I said, HIQA went there and one of the reasons it did so was that it had received notifications concerning the protection of residents. This was after the court case and after the 11-year jail sentence was handed down. HIQA deemed that the home, in terms of the protection of residents, was - believe it or not - compliant. HIQA said there was evidence to show that where allegations of abuse were made, the provider acted according to best practice in ensuring that the alleged victim was prioritised, protected and provided with the necessary levels of support. The provider was "keen to learn from instances where allegations were made". The fact is that on the files of that nursing home, as I understand it, there are at least seven other cases of allegations of rape or sexual interference. There was medical evidence that there was vaginal bleeding and infections. There was evidence that this lady and other people in this nursing home had serious medical issues as a result of the allegations that they made, which were not believed at all. This does not seem to have been looked at by HIQA when it went into the home. How in the name of God can HIQA give a "compliant" report to a nursing home when somebody working there had been given an 11-year jail sentence for raping a woman? The files, which were not looked at by HIQA or shown to it, show that a significant number of other people were abused.
I have a number of questions but I appreciate that the Minister of State may not have the answer to all of them today. HIQA says that it looked at 21 files. How many files were in that nursing home? Were there any files of females who had been living there while the perpetrator was employed there that were not looked at? That goes to the heart of the weakness in the system, which the Government, the Minister of State and I, as a Deputy, want to protect people. There are more than 500 nursing homes here and 31,000 people will sleep tonight in those homes but we have not guaranteed their safety. We have not ensured their protection. HIQA, for whatever reason, gave this nursing home a clean bill of health in its report without knowing the full facts. The facts are, according to a reply to a parliamentary question, that in 2020 there were 18 sexual abuse allegations in relation to nursing homes and centres for people with disabilities and 14 further allegations in 2021. Was HIQA notified of those sexual abuse allegations? If so, why did its inspectors not know about it? If HIQA was not notified, why did its inspectors not look at the files when it went into the nursing home?
There is a serious deficit in relation to the powers of HIQA and the unacceptable outcome of its inspection, where it gave a nursing home a "compliant" report when clearly the home was not. Huge evil was uncovered at the time that HIQA inspectors were in that nursing home.
Mary Butler (Waterford, Fianna Fail)
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In the three years that I have been coming into the Dáil as Minister of State with responsibility for older people, this is one of the most difficult days for me, to come in to discuss the rape of an elderly lady in long-term residential care, her home from home.
I thank Deputy O'Dowd for raising this matter and for his constant advocacy for older people in long-term residential care, which I really appreciate. I am really upset and devastated that "Emily" was failed in this way. She and her family made the difficult decision to seek nursing home care, where she should have been safe but this was not the case. I am thinking of Emily's family, as is everybody, and all the other families who will be traumatised by the issues raised in this report. This has caused huge upset. Today, I want to acknowledge and think of her. It was due, in the main, to the bravery of Emily that the perpetrator of this despicable crime was arrested quickly following the incident, convicted in 2020 and sentenced to 11 years in prison.
Our primary focus must be the safety, protection and well-being of those in our care and to reassure them and their families that we are doing all that we can do to safeguard them from harm and abuse. The HSE has commissioned two separate examinations to date, one through the HSE safeguarding structures and one through the national independent review panel. As the HSE has said, both of these processes have identified a number of deeply concerning issues. I welcome the HSE's unequivocal apology for the failures in Emily 's care. I also note and very much welcome the decision of the CEO of the HSE to appoint a safeguarding expert from another jurisdiction to support the HSE's considerations of the issues arising, both in terms of the facility in question and also, importantly, for the wider context of all those we care about. It is important that we allow time for this process to take its course. I am really sorry.
James O'Connor (Cork East, Fianna Fail)
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Minister, I acknowledge the severe gravity of the subject. If you want to take a moment to compose yourself, I can ask Deputy O'Dowd to respond.
Mary Butler (Waterford, Fianna Fail)
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No, I am fine. I would like to assure the Deputy that my Department is engaging closely with the HSE to ensure that this is undertaken in a timely and comprehensive manner.
There is already a strong framework of standards, policies and procedures in place across the health sector for the safeguarding of adults who may be at risk of abuse, harm and exploitation. In addition, the current HSE adult safeguarding policy addresses every form of abuse, including sexual abuse. The HSE's adult safeguarding policy includes a zero tolerance approach that requires staff to report all abuse concerns, criminal or otherwise.
Nursing homes are required today to have in place policies and procedures to ensure residents are protected from abuse. They are also required to provide training for staff to ensure they can recognise, respond to and report any suspected abuse allegations. If immediate risks to the safety of residents are identified, they are expected to take action and prevent a recurrence. That did not happen in this case. Residents did not have their voices heard. There were other women apart from Emily and we do not know if they went through the same thing. This can also include, where required, a referral to An Garda Síochána. Nursing homes are also required to notify the chief inspector of HIQA of any suspected or alleged actual abuse within three days.
The Deputy will also be aware that I moved to introduce a patient advocacy service and it commenced its phased roll-out to private nursing homes in December 2022. It has been focusing on raising awareness of the services it provides in nursing homes nationwide.
The voice of those living in nursing homes must be heard.
3:35 pm
Fergus O'Dowd (Louth, Fine Gael)
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I thank the Minister of State and acknowledge, as I stated at the outset, her absolute commitment to her work. I support her and believe she is doing her best, but the Government is not doing enough. I wish to make that clear. Where is the commission on care that was promised in 2020? There is no sign of it. Where is the commissioner for older people? There is no sign of him or her. I know these are rhetorical questions. Where is our care and concern? There is no justice or closure here.
I refer to a lady whose husband died of sepsis in a nursing home after a head wound became infested with maggots. She has received no justice. I asked the Minister for Health, Deputy Donnelly, whether he was aware of the case and if he could confirm it had been referred to the Garda. The reply stated: "I have not been made aware of any referral of the nature referred to by the Deputy." I am deeply unhappy with the Minister for Health and the Government for not doing enough to protect the vulnerable in society and stand up for them like the Minister of State, Deputy Butler, does. I acknowledge the pain and hurt caused to those families.
Imagine if somebody in your family was raped. These were vulnerable elderly women. How more vulnerable can you be than having some evil monster coming in to do that to you in the middle of the night during a Covid pandemic? I would like the House to have a proper debate in the next week or so on all these issues. I want the Government to do the job it promised to do but is not doing. These people are not being protected enough, notwithstanding my concern and that of the Minister of State. We need the Minister of Health to come to the House to account for his lack of action on and attention to the care and welfare of older people in society. I condemn him for not standing up for them and not fulfilling the programme for Government.
Mary Butler (Waterford, Fianna Fail)
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Adult safeguarding is an important matter for all of society and all agencies and Departments. On Tuesday night, I read the full report into what transpired in that nursing home. I would not ask any of my colleagues to sit at 11 o'clock at night and read a report like that. It was very distressing.
I wish to be clear that relevant legislation is in place and applicable across all sectors. There are structures and processes in place to protect against abuse and ensure prompt action in the health and social care sector and additional policy development is under way. The HSE adult safeguarding policy includes a zero tolerance approach that requires staff to report all abuse concerns, criminal or otherwise. When matters of a criminal nature arise, An Garda Síochána should be informed in addition to HSE safeguarding and protection teams. The abuse of a person who is in the care of the State is completely unacceptable and must be condemned unequivocally.
Two reviews have already been undertaken by the HSE. I note that Bernard Gloster, CEO of the HSE, stated, "I am not satisfied we yet fully understand all of the issues in this facility [that is a powerful statement] or indeed for those arising for the wider care context." I welcome his decision to commission the services of a safeguarding expert from another jurisdiction to support the HSE's further consideration. As I stated, my Department is finalising a draft national policy on adult safeguarding in health in order to strengthen the current framework.
Even if that legislation was in place, however, I do not know how we could stop a person who wants to commit a crime like that. I refer to the culture that was in place in the context of that particular incident. The most important thing for me is that the voice and choice of older people will be heard. You can speak forever but it does not good unless you are listened to. You have to be listened to. It relates to the culture. There were other people who raised concerns. The report states that those in question may have had delirium, dementia or a urinary tract infection but the signs were there. As a result, after what happened to her, Emily did not get to enjoy her last days and her family did not get to enjoy them. There is absolutely no tolerance of this by anyone in the House or in society. You cannot have a situation like that. I am sorry for getting upset. I know we are all together on this and want to see the best for older people. There are 22,500 people in nursing homes today under the fair deal scheme. There are another 31,5000 people in long-term residential care. We all have to know they are protected and supported and living out the best days of their lives. I apologise for going over time.
James O'Connor (Cork East, Fianna Fail)
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That is no problem, given the gravity of the topic. I am sure all present agree it deserved the time. I thank the Minister of State.