Phil Prendergast (Labour)

It is nice to see the Minister of State again. I welcome most of the standards proposed in this document, particularly those aimed at maintaining the dignity of those in long-term care. However, there are some areas that need to be examined more closely or at least need more explaining. It is essential, after all the delays over the fair deal scheme for nursing home residents, that we get this right first time and that proper standards are implemented quickly.

While the fair deal plan kept falling foul of the law, these standards could fall foul of a lack of clarity. My observations here are intended to be constructive but I cannot ignore the fact that the Minister was energised by the fair deal scheme because she was in search of revenue. These standards, however, are going to cost money — €110 million according to the Minister's own estimate last year — and, therefore, we need a timescale for the adoption of these regulations and we need a commitment that the finance required will be made available. The current economic climate, and the Government's predilection for cutting services rather raising revenue from the rich, could render these standards well-meaning but of little use. We cannot allow the Government to use these standards to create the illusion of finally taking action in the wake of the Leas Cross scandal. That has been well flagged by other Senators who have spoken, and everyone has been rightly appalled at what happened there. There is every reason to be concerned when we consider what has happened to older people in the past few weeks.

I want to be constructive and not approach this from a political point of view. However, just as there is a danger of political exploitation, there is also a danger of commercial exploitation contained in these standards. Private care can be a big business and any room for competitive advantage in the sector could be seized upon if all of the regulations are not clearly spelt out. We cannot have any ambiguity in the standards or in the timeframe for their implementation. Unfortunately, there are grey areas, which I fear could lead to some of these standards not being implemented for years to come, if in fact at all. For instance, there are regulations about the care setting in terms of decoration, bedroom size, bathroom-to-resident ratio and so on, but there is scope in the regulations for homes to defer these works for years. Perhaps they will not have to upgrade their facilities at all. The Minister will need to be particularly clear about the meaning of the following passage on page 6 of "National Quality Standards for Residential Care Settings for Older People in Ireland", which states:

In order to be registered the residential care setting must comply with the regulations. If the setting is not in compliance with the regulations it may fail to achieve registration status or it may lose the registration status. However, it is likely that in some situations the residential care setting will be given a conditional registration for a defined period of time during which it will be expected to come into compliance with the regulations.

In the case of those standards which are not regulatory standards, or standards linked to regulations, failure to comply will not in themselves lead to failure to be registered or loss of registration, but they are designed to encourage continuous improvement.

I am worried about the ambiguity of this because there is scope there not to follow through on compliance with the regulations. It sounds a bit like a get-out clause. If one nursing home can increase its margins by skirting the regulations, others are sure to follow.

On the subject of money, another concern is that the regulations provide no explicit protection with regard to charges. The individual care plan and contract should, I believe, include guarantees on fees, especially with regard to increases and new services. The standards quite rightly include rules about how nursing home staff deal with residents' money, but let us not forget what came out in the aftermath of the Leas Cross scandal. What about how the Government treats residents' money? For instance, where stands the medical card entitlement of people in care, with differing charges and differing levels of on-site medical care? What happens if they are unfairly or illegally dealt with by the provider, be it private or State? Should this not fall under the independent remit of the inspectorate? If not, will the upcoming nursing home Bill address this issue?

Monitoring of these standards is to be carried out by the Social Services Inspectorate. To be effective, it will need more staff and a set of effective inspection and reporting procedures. HIQA's document states a lot about the standards that should be observed but nothing about the practicalities of enforcement. Steps have been taken to recruit more staff — I am aware that we are operating under very tight constraints — but the Minister must outline how many inspectors she will appoint and the targets she will set for them. We need this type of detail in order to be assured that these standards can be properly enforced. We have good reason to be concerned about whether the inspectorate will be truly effective. Twenty-five years ago, the Department of Health itself recommended, in a major strategy document, independent inspections of nursing homes.

I thank the Minister of State for listening to the points I have made this afternoon. I agree with the points made by other speakers, particularly Senator O'Toole, about the practicalities of the issues. The dignity of older people must be sacrosanct and I believe the thrust of this forthcoming legislation is helpful. I look forward to its implementation and I look forward to the Minister of State's clarification of some of the issues I have raised today. I thank her again for the time she is giving to come to the House and listen to these debates, which are helpful in terms of how we deal with issues that are affecting us all. If they do not affect us now they certainly will in our future.