Mary Harney (Dublin Mid West, Progressive Democrats)

Under the Commissions of Investigation Act 2004, a commission of investigation may be established by the Government, based on a proposal by a Minister, with the approval of the Minister for Finance, to investigate any matter considered by the Government to be of significant public concern. How the State and its institutions protect vulnerable people is, in my view, a significant issue. It is evident a systematic review of the management, operation and supervision of Leas Cross is a matter which falls into this category. As this House is aware, the Health Service Executive, HSE, commissioned Professor Des O'Neill, consultant geriatrician, to carry out a review of deaths at Leas Cross nursing home between 2002 and 2005. This review examined the case notes of those patients who died while resident in Leas Cross between 2002 and 2005 together with documentation from the home, the HSE, the coroner's office, the registrar of deaths and the Department of Health and Children. The report was published in November 2006.

The principal finding of the report was that the documentary evidence was consistent with the care in Leas Cross being deficient at many levels, and highly suggestive of inadequately trained staff, and furthermore no documentary evidence that the management of the nursing home and clinical leadership recognised the ensemble of care provision required to meet the needs of the residents.

This review focused on the care of the patients in Leas Cross nursing home and was a paper-based investigation. It highlighted the importance of promoting the highest standards of care for older people and of ensuring a robust and thorough system of inspections. Action has been already taken to address the concerns raised by Professor O'Neill's report. These include the publication by me in January of draft standards for all long-term residential care facilities for older people which are now going through a consultation process led by the Health Information and Quality Authority, HIQA, and the Health Act 2007, recently passed by this House, which has put the social services inspectorate on an independent statutory footing and which contains provisions to underpin a more robust inspectorial system.

What is required now is a review of the systems in place and the roles and responses of all the main parties involved in Leas Cross. Having considered Professor O'Neill's report the Government is of the view that a commission should be established to investigate this matter, which is clearly of public concern, under the Commissions of Investigation Act 2004. This has been decided taking into account the gravity of the issues outlined by the review and the public interest in the outcome of the review.

The draft order is accompanied by a statement of reasons for establishing the commission, as required by the Commissions of Investigation Act, and a similar motion will be brought before Dáil Éireann. Under the provisions of the Act, the order establishing the commission must specify the matter that is to be investigated. The draft order which is before the House describes this as matters relating to and arising from the review carried out by Professor Des O'Neill in examining the deaths of residents at Leas Cross nursing home, the role and responses of such relevant parties as the commission may determine, including the Health Service Executive, and previously the relevant health boards, regarding the ownership, operation, management and supervision of the nursing home and the circumstances surrounding the transfer of patients from other facilities to the nursing home.

I have already mentioned my recent publication of the draft national standards for residential care settings for older people which update the previous provisions set out in 1993 in the care and welfare regulations. These standards, when finalised, will apply to all residential settings, public, private and voluntary, where older people are cared for and for which registration is required. The draft standards are based on legislation, research findings and best practice. The homes will be inspected against the standards, when finalised after the current consultation process, by the social services inspectorate which is a part of the HIQA. It will be independent in exercising this function.

The HSE is currently carrying out inspections of private nursing homes and produced a report in 2006 on nursing home inspections and registrations. There is now in place a national standardised approach to private nursing home inspections across the country. This currently underpins the inspection process. I allocated an additional €6 million for the further development of the inspection process in 2007 and 2008 and the HSE has informed me that 113 inspections have been already carried out this year. A total of 870 inspections of more than 400 private nursing homes were carried out in 2006. Last year, we funded the largest ever expansion in services for older people with a full-year cost of €150 million and this year, we have gone a step further, with a full-year package of €255 million. In two years we have added more than €400 million to services for older people.

We know that remaining at home is the first choice for older people and Government policy is to support people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not possible we support access to quality, long-term residential care. In this regard it is important that older people have access to the best residential care possible. This Government is committed to ensuring the safety of all our citizens but in particular the most vulnerable in society. A high priority is to ensure the safety of older people who, through their hard work, have put us on the road to the prosperity we have enjoyed for the past number of years. The older population has made an invaluable contribution to all aspects of Irish life. We acknowledge this and we are fully committed to improving all aspects of the lives of older people, not only by focusing on health issues but also by giving consideration to quality of accommodation, security, welfare, and all other issues which affect them.

This is why I am recommending the establishment of this Commission of Investigation. We need to ensure the systems in place for those who are vulnerable and in need of residential care are of a high standard and that they receive quality care and treatment in suitable surroundings. To do this we need to examine the system failures regarding Leas Cross. The terms of reference I have approved will, I believe, result in a focused and timely investigation.