Seán Power (Kildare South, Fianna Fail)

I welcome the opportunity to address the Seanad on this sensitive issue. Like other Members and the public in general, I was extremely disturbed by the findings of "Prime Time" last Monday. It is outrageous that older people should be subjected to the type of environment portrayed in the programme and I am pleased that the Health Service Executive has reached agreement with the owners of the home to bring much-needed improvement into the operation of the facility.

The Health Service Executive, northern area, has assigned a director of nursing and senior nursing staff to ensure the delivery of the highest standard of patient care in Leas Cross on a 24 hour basis. A clinical governance steering committee is being established. This will be multidisciplinary and will also involve a representative of the residents' families and an independent expert. The steering committee will oversee implementation of all recommendations as above. An independent inquiry team is being established to investigate all areas of concern. The HSE, northern area, will be exploring all options regarding the future management of the home.

The agreement reached yesterday between the HSE and the home ensured that a director of nursing from the HSE began work in the home today. I have asked the HSE for a report on the latest position on the home, including the steps being taken to improve the unit. I have also received a commitment from Mr. Michael Walsh, chief executive of the HSE, northern area, that I will receive a progress report in one month's time on the operation of the action plan.

In addition to my meeting yesterday with the HSE, I wrote to the Garda Commissioner and requested that gardaí meet with the HSE as a matter of urgency to discuss any issues that might be followed up by them. I hope there will be a visible and significant improvement in the welfare of the residents of Leas Cross and a happier future for them and their families.

It has been the policy of successive Governments to maintain older people in dignity in their own homes for as long as possible, and to provide high-quality, long-term residential care for older people when this is no longer possible. It is internationally recognised that only 5% of the older population will need long-term care. However, people are now living longer lives and though most are leading healthy independent lives, the number in need of long-term care is increasing. There is demand on public long-stay places and there is a growing reliance on using private nursing home places. Many homes provide excellent nursing and care support for their residents and will continue to do so.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. The regulations only apply to the private nursing home sector and do not cover public long-stay facilities for older people. However, there was a commitment in the health strategy document, Quality and Fairness — A Health System for You, to extend the role of the social services inspectorate to other social services, including residential services for older people. The social services inspectorate will be established on a statutory basis and will be totally independent of the Health Service Executive. Its work will cover both public and private nursing homes and the Bill will be published later this year to put it on a statutory basis.

The Department of Health and Children is reviewing urgently the operation of the Health (Nursing Homes) Act 1990 and the Nursing Home Regulations 1993 to strengthen the powers available to the Health Service Executive. This will be a wide-ranging review which will have the rights and welfare of the resident as the centre of its work. It will update the Health (Nursing Homes) Act 1990 and the regulations so any issues regarding employment law, training of staff and so on are reflected in the new legislation. I intend to publish the Bill this year so we can have an open debate that will include all interested parties on a new environment for patients in nursing homes.

Information is one of the most critical issues to be covered by the Bill. It is simply not satisfactory for people not to have comprehensive information easily available on services provided in nursing homes. The new Bill will include a clear statement on easy access by the public to inspectors' reports on nursing homes. The HSE will be developing a common national approach to the inspection of nursing homes. This work will be significantly helped by the fact that the HSE is a national agency and can implement a common policy more easily than heretofore when we had ten health boards and the Eastern Region Health Authority. The work of the HSE can complement the social services inspectorate when it is established on a statutory basis and common standards of inspection are applied.

The Government's commitment to the development of a comprehensive range of services for older people can clearly be demonstrated by outlining the resources made available in recent years for service developments. Since 1997 additional spending on health care services is in excess of €302 million. In 2005 alone, it is estimated that €1,068 million will be spent on care of older people. This funding will be used for a variety of services including the nursing home subvention scheme, home care grants, home help service, an elder abuse programme and support to voluntary organisations. The Health Service Executive has piloted home care grant schemes as an alternative to long-term residential care to assist older people living at home. Older people who are being discharged from acute hospitals and those living in the community are being targeted under these schemes.

In the HSE, eastern regional area, people have been discharged from acute hospitals under the Slán Abhaile and Home First pilot projects. These programmes aim to prevent the inappropriate placement of older people in long-term care settings, including private nursing homes, by facilitating older people who wish to go home following treatment in an acute hospital with the necessary home support services; to provide a timely and well-planned discharge to older people in hospital, thus reducing the number of days spent in hospital following treatment; to prevent unnecessary re-admission to hospital; to support vulnerable older people to remain living at home; and to support families who are caring for vulnerable older relatives at home. In the HSE, southern area, a similar project called Curam has been piloted, while the Choice programme in the HSE, north-west area, also provides such a scheme. The development of a national home care grant scheme is in keeping with a key recommendation in the O'Shea report on the nursing home subvention scheme which recommended that the health services develop a home-based subvention scheme for older people as an alternative to long-term residential care. Funding of €2 million has been allocated to the HSE in 2005 to develop the scheme further.

There have been improvements in recent years in developing telephone supports for older people who may feel defenceless. The senior helpline, telephone 1850 440 444, was established with the support of the health boards in 1998 and has received in excess of 10,000 calls from lonely older people nationwide since 1999. The service is confidential and non-directive and is available throughout the State for the price of a local telephone call. The HSE indicates that there are now some 300 volunteers working from nine centres across the country. These are all older people who have gone through the rigorous training which is provided in conjunction with the health authorities.

Since 2004, the Department has allocated funding totalling €72,800 for a promotion campaign aimed at raising awareness of the telephone number of the senior helpline. The HSE informs me that this telephone number was circulated to all doctors' surgeries in the State. In County Meath, the Summerhill Active Retirement Association received national lottery funding totalling €15,000 in 2003 to produce a booklet and promote the senior helpline. In December 2003, the HSE supported an independent evaluation of the helpline. This was carried out by Dr. Eamon O'Shea of the National University of Ireland, Galway and launched by the President, Mrs. Mary McAleese, who is patron of the helpline, in 2004.

The HSE supports the implementation of the recommendations of the evaluation and this implementation is now well advanced. The senior helpline has responded to issues of elder abuse since its foundation. Volunteers have received specialised training, funded by the former health boards and provided by health service professionals specialising in the area of elder abuse, to enable them to deal with calls of this nature. Approximately 5% of calls in 2004 related to elder abuse. These callers establish a relationship of trust over a period of time with the older volunteers who take their calls and are often unable to seek external or professional intervention until they feel secure in discussing their situation.

The senior helpline has expanded in recent years and three new centres are preparing to come on line later this year. In addition, the Department of Health and Children, through the HSE, has agreed to support further expansion of the helpline hours. Later this summer the service will also operate in the afternoons, expanding from a morning and evening service. Each senior helpline centre provides support materials for volunteers, with key contact details of health services appropriate to dealing with elder abuse situations where the caller wishes for such an intervention.

The Government is fully committed to developing the services needed to tackle the problem of elder abuse. In 2003 we established the elder abuse national implementation group to oversee the implementation of the recommendations contained in the report, Protecting our Future — Report of the Working Group on Elder Abuse, which was commissioned by the Government. Funding of €0.8 million was provided in 2003, €0.75 million in 2004 and a further €0.9 million in 2005 to continue with the implementation of these recommendations.

Elder abuse is a complex issue and difficult to define precisely. It may involve financial, physical or sexual abuse, or it may arise due to inadequacy of care. It is defined in the report as "a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights". It is hoped this report, in commencing with a definition of elder abuse, will give older people who feel they are the subject of abuse in any form the confidence to report their anxieties, as appropriate, to a social worker, public health nurse, garda or any professional or care worker.

It is important that the issue of elder abuse be placed in the wider context of health and social care services for older people. As recommended in the report, multidisciplinary steering committees are being established at HSE area level to provide a common response to elder abuse throughout the State. The primary role of the steering committees is to plan, co-ordinate, support, monitor and evaluate an approach suitable to that particular HSE area. The report recommends that a clear policy on elder abuse be formulated and implemented at all levels of governance within the health, social and protection services in Ireland. The committees are in the process of developing clear policies and guidelines for the protection of vulnerable adults following wide consultations with staff. Their work is progressed through subgroups on legal aspects, policy and procedures and training.

The HSE continues to provide and develop multidisciplinary training for internal and external staff as recommended in the report. The issue of elder abuse is being incorporated into professional training courses including gerontology courses. A number of research projects are ongoing, including the examination and review of medication for older persons in continuing care settings.

In regard to the funding of long-term care, the Mercer report on the future financing of long-term care in Ireland, which was commissioned by the Department of Social and Family Affairs, examined issues surrounding the financing of long-term care. A working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established following the publication of the report. The objective of this group is to identify the policy options for a financially sustainable system of long-term care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea.

The group has been requested to report to both the Minister for Social and Family Affairs and the Tánaiste by the middle of 2005. Following this process, it is the intention that there will be discussions with relevant interest groups. In the interim, work has been carried out in a number of HSE areas on developing standards for residential care for older people. In addition, the Irish Health Services Accreditation Board has commenced work on examining the development of accreditation standards for residential care for older people, both public and private. In this regard, it is developing a pilot programme which includes both public long-stay units and private nursing homes.

It will be clear to Members from what I have outlined that the Government's commitment to older people cannot be denied. We acknowledge that we must continue to develop legislation in this area to meet the growing demand for services and that we cannot be complacent about this. This Government and its predecessor can be proud of their record to date but there is no room for complacency and we must continue with our efforts.