Camillus Glynn (Fianna Fail)

There is no point in codding ourselves about that. Senator Browne made a surprising remark to the effect that nursing staff were not aware that patients were dehydrated. Any member of the nursing profession who is caring for people, especially elderly people, and does not know whether a patient is dehydrated should not be working as a nurse. He or she should be struck off. Whatever happened to the use of fluid balance charts, bowel charts, TPR charts and blood pressure charts, etc? If a patient is non-ambulant, it is obvious that the only liquid he or she will ingest is what is given to him or him either orally, by Ryles tube or intravenously. It is not sufficient to state that a member of the nursing staff would be unaware of whether a patient is dehydrated. If that were the case, the nurse in question would not be doing his or her duty. If nursing staff are unaware of what were previously known as intake and output charts but are now referred to as fluid balance charts, bowel charts etc., it is clear they do not know their job and should not be doing such work. It annoys me that such a situation obtained.

Two and a quarter hours is very little time for a debate of this magnitude. We should revisit this report as it contains a significant amount of information.

Senator Browne made an important point about staffing levels. The level of staffing in geriatric medicine is most important as it is a labour intensive nursing discipline. Sufficient staff are required because, as people get older, they become more limited in their movements or may become completely debilitated. Mechanical aids are now available for lifting elderly patients but a high degree of personal input is also required by nursing and care staff. Therefore, if a ward is short-staffed, even by one member, regardless of his or her level of expertise, this can result in serious problems for the level of care offered to patients and also impact on the staff in that proper health and safety standards can be compromised.

The care of pressure areas is of the utmost importance for non-ambulant patients confined to bed. It is not rocket science. Any student nurse in his or her first two weeks would be shown how to treat pressure areas. One must ensure that the patient is turned, that the position is changed regularly and that the various pressure areas such as the heels, buttocks, shoulders, elbows and hips are not left in the one position for any length of time. Those areas to which I have referred should be also massaged with soap and water. That would not involve a huge cost. The application of barrier cream and other such preparations would compliment and ensure the retention of the elasticity of the skin.

It is clear from the report that normal nursing practices were not followed. Nobody can tell me that all this happened under the noses of doctors and senior nursing staff. It is obvious people were not doing their job. The Minister is right; this issue must be dealt with in the context of legislation. It is depressing to say the least.

On the issue of the visiting committees, I always took the view when I was a member of the Midland Health Board and part of a visiting committee to St. Dympna's in Carlow, St. Loman's and St. Mary's in Mullingar, St. Vincent's in Mountmellick or wherever, that if Senator Browne and Senator White visited as members of the relevant health board, invariably there would be people in the institution who would recognise them and the visiting politicians would recognise the people. That was a friendly face and another contact. There would always be conversation between the visiting committee and those in the institution and it was of great therapeutic value to the patients. A few years ago, I recall reading the reports of visiting committees prior to the establishment of the health boards when members of the visiting committees were critical of standards observed in the course of their visit. Those institutions were revisited time and again until the problems were addressed. Sometimes change is not always for the better.

It is clear from Professor O'Neill's report that he did not engage in an exercise of blame nor did he recommend disciplinary action. Some people involved have challenged his assessment. The report has been sent to the Garda and the Medical Council for their consideration.

The HSE is right to say that his work with the local inspector to achieve an improvement in care standards was ineffective. However, similar work undertaken by the same team and other teams elsewhere have been very effective in other care settings. The majority of care settings provide high quality, safe care to the residents, and they and their families are happy with the care provided.

There may be a misconception about staffing levels in certain care institutions. It is important to have appropriately trained staff and good care staff. Some basic training is important, a matter to which the Minister of State referred. The basic care models are very important in a geriatric nursing centre and can provide the people concerned with a good quality of life.

I sincerely regret, and it is a matter of regret to every Member of this and the other House, that deficiencies occurred. I hope we never have to consider such a report again. Clearly there were failings. I am not convinced that those at management level in that institution were doing their job. If they had done their job properly, this would not have happened.