Seán Power (Kildare South, Fianna Fail)

I welcome this opportunity to address the Seanad on the important matter of the Leas Cross nursing home report. The Health Service Executive, HSE, published Professor Des O'Neill's report into the deaths of residents of Leas Cross nursing home on Friday, 10 November 2006. I deeply regret the upset caused to older people and their families affected by the deficiencies set out in the report. We are learning lessons from this and the Department of Health and Children and the HSE intend to implement significant changes.

Many of the recommendations contained in the report relate to standards for long-term residential facilities and to inspections of nursing homes. I emphasise the safety and well-being of our older citizens are of the utmost importance to both the Department and the HSE. The Government is committed to ensuring high quality care to all older people in public, private and voluntary nursing homes and is working towards having in place the best standards and inspection processes to achieve this. Many developments have taken place in the past several months to further improve the quality of life of older people.

Emphasis has been appropriately placed on developing new nursing home standards. It is important to note that standards already exist for private nursing homes. These are set out in the Nursing Homes Regulations 1993, on the basis of which inspections are carried out by the HSE. The regulations cover several aspects of nursing home care, including health and safety issues. However, they apply only to private nursing homes. The Department is anxious for the introduction of a new set of standards for long-term residential care for older people. It was to this end that the Minister established a working group last year to produce draft standards for all long-term residential settings, public, private and voluntary, in conjunction with the relevant bodies. The Department is in discussion with interim Health Information and Quality Authority, HIQA, on a consultation process on these draft standards.

The standards are based on legislation, research findings and best practice. While broad in scope, the standards acknowledge the unique and complex needs of the individual person at the centre of care. They also acknowledge additional specific knowledge, skills and facilities needed for service providers to deliver a person-centred and comprehensive service that promotes health, well-being and quality of life.

The standards are set out in two parts. The first focuses on the standards concerning the resident as an individual and includes personal identity, social connectedness, rights and health care. The second focuses on the organisational aspects of the residential care setting and includes management, staffing, care environment and health and safety. The Health Bill 2006 will establish the HIQA, and will put the social services inspectorate, SSI, on a statutory basis within HIQA. It is intended that the SSI will be required to monitor residential services provided to older persons against standards adopted or set by HIQA. This is in accordance with the commitment in the health strategy, Quality and Fairness — A Health System for You, to extend the remit of the social services inspectorate to other social services, including residential services for older people.

The fundamental objective of the Health Bill 2006 is to have a health and personal social services system which has quality and safety embedded at all levels and in all settings. The registration and inspection system for residential services will provide a quality assured residential system for persons in receipt of these services. The proposed robust inspectorial system will take account of situations where centres are not in compliance with regulations and standards. It will provide for attaching conditions to registration or cancellation of registration, if appropriate. This will ensure ultimately only services which are provided in line with the regulations and meet the standards set by HIQA will be allowed to operate. It is, therefore, a priority to establish HIQA and the office of the chief inspector of social services on a statutory basis. The Department has been working closely with the Office of the Parliamentary Counsel and work is at an advanced stage on the draft provisions. The Bill will be published before the end of the year.

The Bill will yield a number of tangible benefits. It will help ensure all persons receiving services under the Health Acts 1947 to 2006 have them delivered in accordance with quality and safety standards. It will also have a positive impact on public confidence by enabling persons to have greater confidence in the safety and quality of the health care they and their families receive, especially the safety and quality of the residential services being provided.

HIQA's main role will be to enforce internal quality assurance practices at all levels in the health delivery system and, at the same time, bring to bear external quality assurance in an objective manner. To that end, the Bill ensures quality of services will be monitored and evaluated against transparent standards on an ongoing basis.

Safety is the most fundamental aspect of health care quality. HIQA's proposed functions will include setting and monitoring standards on safety, quality in health and personal social services provided by the HSE or on its behalf and advising the Minister and the HSE on the level of compliance with those standards; carrying out investigations of services provided by the HSE; carrying out assessments to ensure the best outcomes for resources available to the Executive; carrying out assessments of health technologies; evaluating information on health and social services and the health and welfare of the population and advising the Minister and the HSE on deficiencies identified; and setting standards and monitoring compliance with those standards. Other functions relating principally to information technology and management, as referred to in the 2004 national health information strategy will be assigned to HIQA under a future health information Bill being prepared by the Department.

The new statutory office of the chief inspector of social services will continue the SSI's work of inspecting residential centres for children in need of care and protection. The inspectorate has been operating on an administrative basis since 1999 conducting inspections into residential child care services managed by the HSE under the statutory powers contained in the Child Care Act 1991. The new office, however, will have wide-ranging additional responsibilities including inspecting residential services for persons with a disability and for older people, including public and private nursing homes; registering these services based on regulations provided for in the health Bill or the Child Care Act 1991; inspecting the HSE's foster care services, the scheme for boarding out of older people and the delivery of their pre-school inspection system.

The chief inspector will inspect residential centres for children, older people and people with disabilities for compliance with regulations made by the Minister under the legislation and standards set by the authority. He or she will have the power to refuse to register, attach conditions to a registration or cancel a registration in the event of non-compliance with the regulations. The standards in respect of residential centres will be admissible in court in any proceedings taken under the Bill. The HSE, and those providing services on behalf of it, must have regard to the standards set by HIQA. HIQA will also be required to monitor compliance with them and report to the Minister and the HSE on the level of compliance found.

The HSE is responsible for carrying out inspections of private nursing homes, and has made many improvements to its nursing home inspections process in the past year. The HSE has worked on updating the inspection and registration process of nursing homes. To this end, the HSE established a working group in July 2005 which reported in July 2006. Among the recommendations of the report was the recruitment of dedicated inspection teams. These teams should have staff with nursing, medical and mental health experience and have other professional staff available to them, if and when needed. The inspection teams will all work from the same standardised checklist to ensure conformity across the entire system. Most importantly, all inspections will be unannounced.

The HSE has made important improvements to its nursing homes inspection process since the working group report was completed. It has been working on the production of a standard inspection report. Furthermore, the HSE has commenced publishing nursing home inspection reports. This is to provide the public with an opportunity to gain information on non-public nursing homes, particularly in the case of individuals who may be considering a nursing home as a future living option. Information of a confidential nature will not be published.

Under the Health Bill 2006, it is the intention that responsibility for inspecting both public and private nursing homes will be passed to the SSI. Accreditation is the longest established and most widely known form of external assessment of health care services throughout the world. In Ireland, in 2002, the Irish Health Services Accreditation Board, IHSAB, was established as a statutory body. IHSAB operates to the standards for international validation set by the International Society of Quality in health care, ISQua. In due course, the IHSAB will be subsumed into the Health Information and Quality Authority, HIQA.

The IHSAB has developed standards for long-term residential settings. However, it should be noted that accreditation standards are voluntary. The IHSAB standards should not be confused with the national standards for residential care, to which I have previously referred. These national standards are core standards and will therefore apply to each residential unit, whereas the IHSAB standards will apply only to the units which decide to go for accreditation.

The Government is considering policies on long-term care for older people. Several principles underlying this policy were agreed with the social partners in Towards 2016. These principles specify, for example, that there should be one standardised national needs assessment for older people needing care. The use of community and home-based care should be maximised. Where residential care is required, it should be quality care and there should be appropriate and equitable levels of co-payment by care recipients based on a national standardised financial assessment. The level of support for residential care should not distinguish between care in a public or private facility. The financial model to support any new arrangements must be also financially sustainable.

It will be clear to the House from what I have outlined that the Government's commitment to older people cannot be denied. The focus is on supporting older people in their homes and communities for as long as possible, and at the same time supporting those who require residential care, if that is the most appropriate care required. This Government is committed to ensuring high quality care for all older people in public, private and voluntary nursing homes and is working towards having the best standards and inspection processes in place to achieve this. By its investment programme this year the Government has demonstrated its commitment to older people. We acknowledge that we must continue to develop policy in this area to meet the growing demand for services and that we cannot be complacent in this regard.

Everything must be done to avoid another Leas Cross. This Government is committed to developing appropriate structures to ensure our older citizens receive the best possible care in the most appropriate settings in the future.