Seanad debates

Wednesday, 29 November 2006

Leas Cross Nursing Home Report: Statements

 

7:00 pm

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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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.

Fergal Browne (Fine Gael)
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I welcome the Minister of State and his official to the House. The Minister of State's last paragraph is laughable. It takes a great deal of imagination and creativity on his part to talk with a straight face about the Government's commitment to older people. I was amazed to learn when listening recently to Vincent Browne's show that on 4 July 2001, Deputy O'Dowd, who was then a Member of this House, put down a motion about care of the elderly. The first paragraph of his speech stated:

That Seanad Éireann, concerned that elderly people will have appropriate, responsive, accessible and high quality care and supports either at home or in extended care settings, such as nursing homes, calls on the Government immediately to introduce a comprehensive package of care supports, including an independent inspectorate of nursing homes, both private and public, an approved quality training programme for care assistants, and the creation of the office of ombudsman or advocate for the elderly.

Senator Glynn was a Member of the House at that time and might recall the debate. The then Senator O'Dowd referred to nursing staff administering the flu vaccine to patients without medical back-up, and in the absence of emergency drugs, which was contrary to safe practice. He spoke about a nursing home where there was no doctor's signature for medications given to a named patient. He quoted the report of an inspection of a home carried out on 22 June 2000, more than six years ago, to the effect that a resident's prescription had not been renewed since November 1999.

The Minister of State's predecessor at the Department of Health and Children, Dr. Moffat, spoke about the Government's policies and commitment to elderly people exactly as the Minister of State did today. He said Government's policy was "to provide high quality hospital and residential care for older people when they can no longer be maintained in dignity and independence at home." Here we are, five years later, in a situation much worse than we ever imagined, as the Leas Cross nursing home has brought home to us all.

Even Dr. Moffat, the then Minister of State, said:

There is concern that while there is provision, as outlined above, under the nursing home legislation for monitoring standards in private nursing homes, no similar arrangements are in place for health board facilities, an issue both I and my colleague, the Minister for Health and Children, will rectify. As Members will be aware, the social services inspectorate has the authority to monitor standards in children's residential centres and is operating effectively. It is intended to expand its role to cover extended care facilities for older people.

It is like Groundhog Day all over again but five years have passed and people have paid, in some cases with their lives, for this neglect. It is shocking to think that some people may have died from renal failure due to dehydration where nurses and staff in nursing homes were not aware these people were dehydrated. If we saw that happening in another country we would call for resources to be put into the country or withdrawn, depending on the context. It is happening here, where our elderly people are denied the dignity they deserve. They are the people who founded the State in difficult times but my generation has never had it so good.

The Minister of State referred to publication of the reports but the HSE has covered only part of the country, and published only some reports on its website. This is still hit and miss because there is not 100% coverage.

I will not enter the debate this evening about private versus public homes. I make no bones about saying I am in favour of private nursing homes. Only for that scheme there would not be half the number of nursing homes there are, and they would not be in their present locations. In County Carlow there are fantastic nursing homes in Tullow Road, Leighlinbridge and Ballon. I would be terrified that if this were left to the public sector the homes would not be built in the first place and if they were they would be located in major urban areas. It is great that people who have to go to nursing homes are able to reside near their homes because it also makes it easier for family members to visit them.

The O'Neill report on the Leas Cross nursing home points to the need for the Government to set in place minimum staff levels. There may be only one nurse on duty in a nursing home. That is not acceptable. There should be clear guidelines on the minimum number of staff required and on inspectors and the number of their visits.

When Dr. Aidan Browne recently addressed the Oireachtas Joint Committee on Health and Children he explained that there are 54 inspectors going around the country and that they visit private nursing homes twice a year. The number of farms is similar to the number of people in nursing homes, at approximately 18,000 but there are only 54 nursing home inspectors, divided into 18 teams of three. I was shocked to learn, from a response to a question to the Minister for Agriculture and Food yesterday, that in her Department there are 1,685 inspectors. There is almost one inspector for every 11 farms while in nursing homes there is one inspector for every 370 patients.

If someone gets food poisoning in a nursing home or the food preparation area is not clean the nursing home can be closed down instantly. Malpractice in the care of the patient, however, can continue without swift remedial action. It took a "Prime Time" programme, and my colleague Deputy O'Dowd who has been raising this issue for years, to expose the scandal in a few nursing homes. It is worth putting on record that many nursing homes offer an excellent service. We were all shocked by the contents of the "Prime Time" programme.

Was the Minister of State, Deputy Seán Power, briefed or warned specifically about the major problems in nursing homes, on his appointment as Minister of State at the Department of Health and Children? Dr. Aidan Browne stated at a meeting of the Oireachtas Joint Committee on Health and Children that the current Act and regulations are cumbersome and that it has been recognised for some time that new legislation and regulations are required.

Many people have been baffled by the slow response of the Government. The "Prime Time" programme to which I referred was aired more than 18 months ago. In contrast, almost two years ago the Government rushed emergency legislation through this House on nursing home charges. Thankfully, that legislation was rejected by the Supreme Court. Almost 18 months later we are still hearing about the inspectorate and other issues relating to nursing homes. The Government is very quick to charge pensioners in nursing homes but very slow to bring in safeguards to protect them while in the care of these same nursing homes.

It is shocking to compare the number of inspectors in the Department of Agriculture and Food with the number of nursing home inspectors. We need to set minimum guidelines. I urge the Minister of State to ensure all inspection reports are made available immediately on the Health Service Executive website so that people are made fully aware of the conditions in individual nursing homes. If any of us were planning a weekend away, we would find out how many stars a hotel had and what facilities were available there. People who want to find a nursing home for themselves or a relative should have the same option but that has not been the case to date. It is vital that nursing homes are brought up to the highest specifications. It is the least we deserve as we get older.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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I welcome the Minister of State, Deputy Seán Power. We must acknowledge the work carried out in the report on the Leas Cross nursing home by Professor Des O'Neill. I am pleased to hear the Department of Health and Children and the HSE will work to implement his recommendations. The failings in care for older people described in the report are deeply distressing. They show a complete lack of respect for older people and their dignity. These people were the founders of the State and the ones who worked in adverse circumstances to make the country what it is today.

In this instance and in others, older people in care and their families were badly let down; in fact, they were betrayed. I deeply regret the distress it has caused them. The fact that the nursing home in question is now closed in respect of the previous management is some small measure, but it is of little comfort to the relatives of those whose loved ones were failed so badly. It is clear that warning signs and complaints were not given the attention they were due. It is vital that the Government leads the legislative actions and funding decisions to ensure that high standards of care are upheld in all nursing homes, both public and private. It is clear from Professor O'Neill's report and from previous reports that complaints and warnings were not given the attention they warranted. This is a matter of deep regret. This is another example of a problem that dates from the mid-1970s that was not dealt with and eventually became impossible to ignore.

Fergal Browne (Fine Gael)
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It took Fine Gael to expose it.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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Fine Gael was in Government and nothing was done about it.

Fergal Browne (Fine Gael)
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The Fianna Fáil Party while in Government extended the medical card to people aged over 70. That was when the issue was highlighted. The Government was warned.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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On behalf of my party, a number of parties were in Government. The issue was not addressed by Ministers for Health and Children of all persuasions. It was the best kept secret in the Houses of the Oireachtas.

Photo of Mary WhiteMary White (Fianna Fail)
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Senator Glynn is correct.

Fergal Browne (Fine Gael)
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Let us return to 2001.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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We will deal with that later. I wish to refer to visiting committees. I was a member of a health board for approximately 23 years. It puzzled me that as a member of a health board I was entitled to visit public nursing homes but not private nursing homes. Although they were also receiving subvention from the public purse, we were not able to visit them. However, if one examines how many public nursing home facilities fell into the same category as Leas Cross, the answer is none. I accept that money can be made from private nursing homes but let us be clear. It is patently obvious that a number of those institutions were profit-driven and the comfort and care of the residents came a bad second place.

Photo of Mary WhiteMary White (Fianna Fail)
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Hear, hear.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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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.

8:00 pm

Photo of Brendan RyanBrendan Ryan (Labour)
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Cuirim fáilte roimh an Aire Stáit. Mar is gnáth nuair a phléimid an cheist seo, I must say something. My mother is in a public old people's hospital in my home town of Athy. Would that all our old people were in receipt of the quality of care provided at St. Vincent's in Athy. If the HSE wants a model of good practice, it does not have to get involved in complicated, complex, time-consuming and slow pilot projects. It has models that work very well to the satisfaction of patients and families and those who visit. I happen to know one and I am sure there are many others.

I do not want to rehearse the horrors of Leas Cross because they have been rehearsed time and again. I did not hear the Minister of State but I read his script. I note the absence of reference to most of the recommendations in the Leas Cross report and considerable emphasis on one issue, that of standards, which is important. We are in danger, as we are often, of the legislative response to a crisis which is to set up a raft of complicated legal procedures and then forget the implementation of those requirements costs a great deal of money. I want to put on the record a little from the report and a good deal from what the HSE supplied Members on the recommendations and what it was doing or, as the case may have been, not doing.

There is a tendency in the HSE's commentary on Leas Cross to give the impression that this matter sprang on it out of a blue sky without any serious prior warning. That is nonsense. I have no idea whether it got lost in the transfer of documents or files or whatever. As the report states, Years Ahead was published in 1983 and as Professor O'Neill said 23 years after it was made official health policy, its recommendation for an independent inspectorate for residential care remains unfulfilled. I fully accept that is the fault of a number of Governments but we are in a unique period in this country's history in that we have had the same Government for ten years and one that has had at its disposal resources which were undreamed of by any previous Government. Of the 23 years, ten have been the period of this Government when it did not have the excuse that Governments of all hues of the 1980s and early 1990s had, namely, that resources were scarce and were being consumed by an armed uprising that spilled over to this part of the island and which incurred substantial damage and cost.

I continue to wonder how long it will take the Government to stop looking back over the horizon of previous Governments. It is ten years in office and considering that the official lifespan of a politician is 20 years — that is when we are allowed to retire on full pension — half the lifespan of a politician is about the time when a Government should stop talking about what its predecessors did or did not do.

Professor O'Neill referred to the health strategy of 2001, its wonderful improved staffing levels and extended care units, the extended remit of the social services inspectorate, and national standards for community and long-term residential care of older people. The latter issue has always raised for me one question. How was it that a health strategy that was compiled in 2001 which referred to those issues never asked how it would be paid for? Clearly if one asked how it would be done, one would look at the legislation and the issue that arose for the Minister, Deputy Harney, but which was conveniently not noticed by her predecessor. How in heaven's name an otherwise very intelligent man managed not to wonder about paying for all that is beyond me. It is also beyond everybody else and I have my own explanation.

What Professor O'Neill's report stated about the health strategy was: "No documentation has been offered to me suggesting movement on these objectives prior to the Leas Cross Prime Time programme". It launched the strategy with rhetoric and did absolutely nothing for five years until it was shamed into it by a television programme. The report continued: "The deeply deficient Nursing Home Legislation and Regulations have been tolerated well beyond what the time span...". We now know this and have known it for some time. The report further stated: "it was with some surprise that the reviewer noted a claim in the OECD overview of long term care that Ireland has put into place national standards of care". Not only were we conning the public at home, we were also conning the OECD by informing it we had done things we had not done. The report continued: "A Cabinet Member ... is documented as being briefed on these deficiencies on 30/5/2005, and the Assistant Secretary of the Department of Health and Children received a comprehensive memo on the grave deficiencies of the current legislation/regulations on 24/5/2005".

Professor O'Neill went on to make a succession of recommendations, most of which were ignored in the speech of the Minister of State. Let me go through some of them. "The Department of Health and Children and the Health Service Executive must in its policy, as a matter of urgency, clearly and formally articulate its recognition of the complex health and social care needs". The response to this recommendation was:

A report of current and future long term needs has recently been completed as part of an interdepartmental working group on the funding of Long Term Care. A national forum with HSE and Nursing Homes representatives is working on a number of quality initiatives including the development of service level agreements.

Some 23 years after the first public policy statement we are to have a national forum. Not one older person in a poor quality private nursing home will get any benefit from a forum. They will just have to wait longer.

Recommendation No. 2 reads: "The provision of this care . . . should be clarified formally in terms of adequate numbers" etc. The response reads:

The Report of the Working Group to examine the development of appropriate systems to determine nursing and midwifery staffing levels was published by the DOHC in Sept 2005 ... It is proposed to have a number of pilot sites across the country that would examine . . .

I will read a few more. Time after time——

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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The Senator should give us his own view.

Photo of Brendan RyanBrendan Ryan (Labour)
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My view is of a monumentally incompetent Department run by monumentally incompetent Ministers and a monumentally incompetent HSE which blames systems failures for everything. Systems failures mean that the managers cannot or will not manage. They mean that the people in charge did not devise proper systems, ignored problems until they blew up in their faces and then blamed everybody else except themselves for the consequences. They now want us all to wait while they get around to formulating the policy they announced five years ago and never implemented. That is my view. Those responsible for this debacle should at least show some urgency.

Recommendation No. 4 reads: "Funding arrangements for nursing home care should be urgently reviewed". The response reads: "Work is ongoing". Give us a break. Work has been ongoing on this issue since the 1990s.

Recommendation No. 5 reads: "The Nursing Home Legislation needs to be urgently updated". The Department of Health and Children's view of the words "urgently" is sometime this year or maybe next year. I do not know what the word means when the report highlights monumentally poor management. I am tired at the pointing of the finger at nurses, doctors, care assistants, ambulance drivers and other while those responsible for managing the HSE get away with the nonsense that there was a systems failure. When an old man bleeds to death, it is a systems failure. "Systems failures" is code for management incompetence. I could go on forever. Each of the HSE responses to the recommendations made in the Leas Cross report is exactly the same and indicates that it is proceeding on a path but there is no hint of a sense of urgency.

The Minister of State wants to know what I would do. First, I would confront the fundamental unstated problem, about which we all know. The Department of Finance is resolutely committed to not accepting any major funding commitment for old people in long-term care. It is determined to extract a pound of flesh, if not hundreds of pounds of flesh, in payments from old people if they have any assets or if their children have any income. We are being held up by the inability to produce before a general election a politically neutral proposal on the funding of long-term care. It is all about running away from the delightful fact that people are living longer and better lives than ever before, which is seen by the Department of Finance as a problem, not something to celebrate. It is determined that we will not accept the responsibility for our old people that we have accepted for educating our children and in so many other areas of life.

I have no idea how bodies such as the HSE and the Department of Health and Children can remain in an apparent state of catatonic relaxation and ignore what is happening. The legislation to deal with standards did not require a huge effort or consultation with European partners or various interest groups. Everybody working in the system, including the nursing home operators, wants this legislation.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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It did require consultation.

Photo of Brendan RyanBrendan Ryan (Labour)
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Not at all.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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The Senator should tell the truth if he is going to speak about the subject.

Photo of Brendan RyanBrendan Ryan (Labour)
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Whatever I am telling, I am telling the truth: I am not making it up.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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The Senator is putting a colour on it.

Photo of Brendan RyanBrendan Ryan (Labour)
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Clearly, if one wants to do something about standards and is waiting for 23 years, one does not need to carry out a consultation process. The Department is full of reports, suggestions, memoranda, lobby submissions, etc., all outlining what people want. It is a smokescreen to cover up monumental ineptitude, inexplicable and unforgivable delays, and a classical Department of Health and Children capacity to operate at a pace that would make a snail look like an Olympic runner. The fundamental problem is that the pace at which the Department can do things is apparently that with which the rest of us, including old people, must live. There is no shortage of resources or ideas on how to address the issue. However, the Department, with considerably reduced responsibility, is still incapable of producing urgently anything like legislation to deal with what should be for most of us one of the most pressing areas of care in the health service.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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I welcome the Minister of State. I smile when I hear Senator Ryan talk about systems failures under the Government. Every time Fianna Fáil is in power there seem to be systems failures. The Senator is right in saying people lie behind such failures, a point he made recently on the Order of Business. If so many Fianna Fáil Governments have been in power, as he says, that is democracy. It is the people voting Fianna Fáil into power. The systems failures happened during the term of office of successive Governments, including those in which his party participated. It was particularly the case in respect of the Travers report on nursing home charges. The Senator should shoulder some of the responsibility and not lay all of the blame on the parties in government.

Fergal Browne (Fine Gael)
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The year 2001 was a key date.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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Senator Feeney, without interruption.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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The Leas-Chathaoirleach will be delighted to know I intend to move away from the party-political arena.

In light of the heavy criticism of the Government, it is time somebody informed Senator Ryan that his party was in power at one stage. He may have forgotten that because it was a long time ago.

On 1 June 2005, the House heard statements on nursing homes. Early that day, Senator Brian Hayes sought for the Order of Business to be changed in order that we might debate the matter. This move came about in the aftermath of the appalling "Prime Time" programme on Leas Cross. I stated at the time that we should not play politics with what emerged in that programme. All right-thinking people were absolutely appalled by the blatant abuse that appeared on their television screens. Examining what I said in that debate, it still makes my stomach sick to read about that which we were discussing 18 months ago, namely, patients being left in wet beds, forced to take medication and bullied, and old men and women being held down and staff cursing at them. It is frightening to think that this happened and that it could happen again.

I am a member of the Oireachtas Joint Committee on Health and Children which last week was addressed by Mr. Aidan Browne, a former nurse and current national director of the HSE's primary care unit. Mr. Browne came before the committee with a team of people and outlined what the HSE has done since the Leas Cross scandal emerged.

At present, there are 436 private nursing homes in operation. Public nursing homes are much better monitored and run than those in the private sector.

Fergal Browne (Fine Gael)
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We do not know that. There are no inspectors.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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Senator Feeney, without interruption.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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The same level of complaints does not arise in respect of public nursing homes. I grew up in Tullamore, County Offaly, and my aunt died at Riada House, a State nursing home, in the town. She received care of a level that was second to none. People in Tullamore are queuing up to gain entry to Riada House. Those wishing to gain a place in the home must undergo a means test.

Fergal Browne (Fine Gael)
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People were queuing up to get into Leas Cross.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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If people are means tested, at least we then know they cannot afford to obtain entry to private nursing homes. People are queuing up to gain entry to public nursing homes.

The team from the HSE informed us that unannounced inspections are taking place. I agree with the carrying out of such inspections, but I have a slight reservation in respect of them. Inspection teams are made up of three people, namely, a nurse, a doctor and an environmental health officer. In my opinion, lay people should also comprise part of the inspection teams and I would like to hear the Minister of State's views in that regard. Lay people often notice things professionals may not notice.

Unannounced inspections are being carried out day and night. If an inspection team interviews an elderly patient, he or she may have very good reasons for not talking. For example, he or she may be afraid do so for fear of being seen as complaining. In addition, that person might fear subsequent reprisals. If a member of such an individual's family could be present, he or she could speak on his or her relative's behalf.

A total of 666 inspections were carried out in the period from January to October. Private nursing homes are continually assessed and those involved in carrying out inspections were happy to state that there is no immediate risk to residents in any of these homes. Private nursing homes are being monitored around the clock and any action deemed necessary in respect of them will be taken.

I asked Mr. Aidan Browne if a bad report relating to a nursing home would be published and how this would be done. He stated that nursing homes which receive such reports are obliged to publish them in their reception areas. I pulled him up on this because I am of the opinion that the word "obliged" is not strong enough. If one is obliged to do something, it means one is not really being asked to do something and that it is up to oneself to do it. There is an obligation but one may not take action. I informed Mr. Aidan Browne that these bad reports should be posted on the Internet or sent to people who are considering placing their loved ones in such homes or to the families of people who are already resident in them.

I was interested to discover that the HSE forwarded a copy of Professor O'Neill's report to the Garda Síochána, An Bord Altranais and the Medical Council. As a former member of the two regulatory bodies, I asked if a formal complaint had been made. I was informed that formal complaints have been made to the Medical Council and to An Bord Altranais. That is quite a serious development. There must be suspicions that certain individuals have questions to answer or that they may have been guilty of professional misconduct.

In fairness to them, the members of the team that appeared before the Oireachtas Joint Committee on Health and Children admitted that some nursing homes cut corners. Those who run certain homes are extremely conscious of profit margins. However, it is important to note that many nursing home proprietors provide high-quality care and their facilities operate to high standards. Many nursing homes with which I am familiar are vocationally driven to deliver quality care and go out of their way to ensure elderly patients are well looked after.

Out of the 436 private nursing homes in operation — it is only to such homes that we are referring in this debate — questions arise in respect of between eight and 12. It is a small number but it is eight or 12 to many. We must adopt a balanced approach. Older people listen to the kind of scaremongering in which individuals engage to score political points and those politicians who engage in such scaremongering do not realise how frightening their words are for the elderly. If I were an old person considering entering a nursing home, I would be terrified by the way Opposition politicians shout——

Fergal Browne (Fine Gael)
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The Senator cannot bury her head in the sand.

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
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What about the politicians who were working in nursing homes?

Fergal Browne (Fine Gael)
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Renal failure——

Photo of Paddy BurkePaddy Burke (Fine Gael)
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Senator Feeney, without interruption.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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——and roar about particular matters. People must take a balanced approach and they must consider older people before trying to score political points.

I am delighted the health Bill will be published before the end of the year.

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
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Yet another one.

Photo of Geraldine FeeneyGeraldine Feeney (Fianna Fail)
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As the Minister of State indicated, the Bill will create greater confidence with regard to the care being delivered to patients. I hope elderly patients will be included in this regard.

Tough lessons must be learned from Leas Cross and we must ensure the type of abuse that occurred there will never happen again. We would not be where we are today were it not for our senior citizens, some of whom are now happily ensconced and being well looked after in nursing homes. We owe a debt of gratitude to these people and they deserve our respect. It is also important to remember that a sense of balance is required in this debate.

Photo of Joe O'TooleJoe O'Toole (Independent)
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I welcome the opportunity to comment on the Leas Cross report. This matter was referred to on a number of previous occasions and the Minister of State, whom I welcome, has dealt with it in public several times.

One of the matters that saddens me about debates of this nature relates to the issue raised by Senator Feeney regarding the scoring of political points. The Senator is absolutely correct that matters of this sort should not be used to score such points. The difficulty is, however, that if she happens to be on this side of the House next year, she will be doing the same thing. I have been a Member of the House long enough to realise that fact, so what she said does not cut any ice with me.

This matter is way above politics. I have studiously avoided laying blame on Ministers or anyone else. However, I believe there are people at fault. In my opinion, we have been misinformed on a number of occasions. We were told, not by the Minister of State, on a number of occasions that legal reasons were preventing the publication of the Leas Cross report. That is what the members of the Joint Committee on Health and Children were told and that was not true.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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It was true.

Photo of Joe O'TooleJoe O'Toole (Independent)
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The report has been published without legal difficulty. This creates a lack of trust and confidence.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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That was the advice the HSE had at the time.

Photo of Joe O'TooleJoe O'Toole (Independent)
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Which is the advice it gave to the Minister of State but it was wrong. Senator Ryan is correct that a systems failure should be attributable to a person. If I were in the Minister of State's position and I were given advice to relate to a committee of my peers which was subsequently contradicted when the report was substantially leaked, I would trace who released the information because that would not be good practice. I accept the Minister of State provided the advice in good faith but I would like to know the name of the lawyer involved and whether he will be employed again by the HSE.

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
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Probably.

Photo of Joe O'TooleJoe O'Toole (Independent)
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These guys are too smart. Many Members were concerned about how the issue of the legal advice would be dealt addressed.

Patients are happy and content in most nursing homes. Recently, I visited a number of nursing homes for a number of reasons. I received a great lift when I sat beside a 90 year old woman from west Clare in the reception area of a nursing home in the midlands. I asked her how she had come to be in the nursing home. She replied that she had no family in Ireland, as her siblings were abroad, and she wanted to stay in a home where she would be looked after. I asked her why she selected the particular nursing home and she replied that she read about it in Woman's Way and it sounded like the kind of place she would like. She was absolutely compos mentis and she was looked after very well. I had called to this home to visit a person who had a high profile in the media until recently but, unfortunately, he is suffering from Alzheimer's disease. He did not recognise me but we had known each other very well over the years. He was well cared for and when I walked into the home, staff were hovering around to help him.

An increasing number of families have relations who need to be cared for in a nursing home because of their age and the family's need for space. Home supports are provided by the Department but I know three or four families that must look after, say, two spinster aunts who live independently but who can no longer look after themselves. The State provides each of them with supports but if they lived together and received the same support, it would take pressure off nursing homes. That is not rocket science. An average person examining systems, efficiencies and value for money would consider this and it should be examined in the budget. Groups of elderly people could be cared for together using the home help service and independent care groups.

Many care support groups and agencies are not subject to inspection or examination and staff employed by them are not subject to legal or security checks. I could outline two worrying cases of individuals who should not have been left on their own in the homes of elderly people. Even though the agency involved was reputable, it had not conducted a check because it was not required to do so. Staff employed by such agencies to provide home support should be registered centrally. For example, security clearances must be provided by those brought into schools as substitute teachers.

The inspectorate is a bad idea, although inspection is a good idea. It is not possible to establish an inspectorate qualified to deal with all the issues raised in the report. Nursing homes should be included in the remit of the local health and safety officer and he or she should be required to forward reports once or twice a year. Similarly, reports should be provided by the local fire officer and general practitioner clinic while a structure should be provided so that families and friends of nursing home patients can have an input into the inspection process. I have heard the arguments about on-the-spot inspections and unexpected inspections during the night and so on. However, no single office can inspect fire hazards as well as all other health and safety issues, the staff-patient ratio and the use of medication.

I would need reassurances that my loved ones are not being drugged up to their eyes, because that is the most important issue. I could live with the temperature being too high or low in the home or a few minor hiccups in the service provided, even though that should not happen. However, the greatest issue is the administration of drugs to those living in the nursing home and that cannot be covered by the inspectorate proposed by the Minister. Everybody is clamouring for it and the political commitment has been made but it is like a soundbite to get people off the Government's back and it is not a good idea. A multifaceted approach must be adopted so that all the issues involved are examined and the appropriate agent is given responsibility for them such as the local doctor, fire officer, health and safety officer, dietician or other medical staff. Medication checks should be conducted and I would be reassured by that. The family and friends of patients should also have a structured input.

The publication of the report in the main hall or reception was a little freaky. While I can understand the argument for doing so, I do not know what that can tell us. It should have been made available to all those who were looking after patients in the home. I did not understand recently why, when four or five nursing homes were suspended, they could continue to operate even though they were not permitted to take in more patients. If they could not take in patients, the issue was probably the staff-patient ratio, but that was not stated. I would like to know if that was the case because it would concern me less than a problem of a more fundamental nature, that is, the care of the residents. I do not know whether publishing these reports will provide the information for which we are looking. This is a matter of trust and confidence and giving people information to make judgment calls in the knowledge that so-called official Ireland has examined the situation and reached certain conclusions.

In other major scandals, such as at Artane and Letterfrack, part of the problem was due to the wrong inspection routine. Inspectors went in and got tea and buns in the parlours, but that did no good. A modern version of the same could occur in this instance if it were always the same inspector visiting. Let us spread the job of inspection to the qualified people, namely, a health inspector, a dietician, a local general practitioner, a fire officer, a health and safety official and, every now and then, someone with a qualification in geriatrics.

There will always be problems. This is not a political issue and we must deal with it in a straightforward and efficient way that provides value for money, restores trust and confidence in the system and looks after our future because all of us will be involved.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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We are lucky.

Photo of Mary WhiteMary White (Fianna Fail)
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The Minister of State is taking the butt of the abuse, but it is important that he does not take the blame for this issue. I am sorry for him because he is doing his best with a hot issue.

In my document, A New Approach to Ageing and Ageism, a copy of which everyone has received, I designated abuse of the elderly under the heading of crime against older people. It states: "The National Council on Ageing and Older People report that between 12,000 and 20,000 older people may be suffering from some form of abuse at any given time." These figures are frightening.

Abuse of the elderly is a serious issue that was not revealed until the Leas Cross incident. My document states:

Elder abuse is a serious issue in Ireland that has not received the same priority as in other countries. The Elder Abuse Response Helpline, set up to help victims of abuse in the UK, received so many calls from Ireland that it now provides a special number — 1800 940 010 — for callers from Ireland.

In October, I attended a conference in Croke Park at which Dr. Maurice Manning, the president of the Irish Human Rights Commission, was the guest speaker. He stated: "Some of the worst abuses of human rights in Ireland can be found in the treatment of older people in long-stay care." Regarding Dr. Manning's speech, the document Ageing Matters in Ireland states:

Older people were identified by the commission when it was established in 2001 as one of the most vulnerable groups in Irish society, he told the conference on the rights and entitlements of older people at Croke Park on 2 October. As a result, the very first piece of research commissioned by the commission was a study of older people in long-stay care, carried out by barrister Ita Mangan.

I am sure that the Minister of State is familiar with the study. Dr. Manning was further quoted as stating:

It was a fine and frightening piece of work which made most of the points which were subsequently effectively and dramatically made in the "Prime Time" programme on Leas Cross. For us, Ita Mangan's report revealed a series of serious human rights breaches. We published the report. Not surprisingly, there was little media reaction and the response from the Department of Health was, I'm sorry to say, perfunctory and dismissive.

He also stated:

It gave us no pleasure when the Leas Cross programme dominated public interest to point out that we had warned the Department and the public much earlier of the defects in current practice and of what needed to be done.

The issue always existed, but we did not know about it until it was revealed on "Prime Time". We could not believe how people were being treated. Regarding systems failure, I do not know how human beings could behave like savages by treating older people in that way.

Senator Browne stated that a comparative study of the private and public residential homes has not been conducted, but a report on the matter was published several months ago. The report, with which the Minister of State's official is probably familiar, referred to better care in public nursing homes. The profit motive has gone wild in private residential homes with the result that everyone is afraid. Senator O'Toole stated that he would not like to see his parents in such a home, but I would not like even to see myself in one. I would shoot myself now.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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We would visit the Senator. She should not worry.

Photo of Mary WhiteMary White (Fianna Fail)
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I thank the Minister of State. I would be delighted to see him.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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We would bring chocolates.

Photo of Mary WhiteMary White (Fianna Fail)
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A significant job must be done. Senator O'Toole referred to the inspectorate, but the matter is not simple. I reflected on what he said. I worked in the public sector of the building industry. Inspections were carried out, but people became so sociable with the other side that they closed their eyes, as it were. A distance must be kept between the inspectors and the owners.

The Minister of State's speech was excellent, especially his last paragraph, but it was ridiculous of Senator Browne to attack him. On behalf of the Department, the Minister of State said:

Everything must be done to avoid a situation such as arose in Leas Cross ever arising again. This Government is committed to developing appropriate structures to ensure that our older citizens receive the best possible care in the most appropriate settings, in the future.

I wish the Minister of State the best of luck in his important portfolio. The issues outlined in my documents, including A New Approach to Child Care, are close to my heart as a Senator.

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
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I welcome the Minister of State. When one leaves a mother, father or someone in a nursing home, the least one expects is that they will be cared for in a professional and caring fashion. What happened in Leas Cross was despicable. People were responsible for the grievous wrongs and practices visited on the old, infirm and vulnerable people in the nursing home. People were charged with supervising the staff working in the home. People in the health authority knew and should have acted to ensure safety and that care and proper attention was given to the patients.

The Government has had a deplorable Pontius Pilate attitude towards accountability. Initially, the atrocities were brought to the attention of the Government by Deputy O'Dowd, the leader of Fine Gael, Deputy Kenny, and a wonderful "Prime Time" programme that shocked the nation and eventually stirred the bureaucratic system into action.

I will return to what Senator O'Dowd, as he then was, said in 2001. For the Government to say it knew nothing of what was taking place does not wash. In a motion before this House in July 2001 Senator O'Dowd called for an independent inspectorate for nursing homes, both private and public, an approved quality training programme for care assistants and the creation of an office of the ombudsman for the elderly. The reply from the Minister of State at the time was to the effect that there was concern about nursing home legislation and monitoring standards in private nursing homes but that he and his colleague, the Minister for Health and Children, would rectify the situation.

That is what the Government promised in 2001. It was fully aware of what was happening because it was brought to its attention. It should not have taken a "Prime Time" investigation to force the Government into action in calling for a report into Leas Cross and investigating other nursing homes. There was a systems failure, which seems to be the catchphrase for all the ills for which the Government is not prepared to accept responsibility. However, people were responsible for what happened in that nursing home. The health board, the Department of Health and Children and the Government knew. Will they be held accountable or will it be brushed under the carpet as so many other things have been?

The families of the patients who were in Leas Cross are correct to band together and demand action. It is the least they deserve after witnessing what happened to their loved ones. This was just one nursing home but many more since have been found to be lacking in basic hygiene, basic staffing levels and other things. I would not wish to tar every nursing home, private or public, with the same brush because the majority are good and care properly for people. However, others need attention and inspection, which were called for in 2001. My colleague, Senator Browne, referred earlier to the large number of inspectors in the agricultural sector to examine farms compared to the numbers inspecting nursing homes. There is one inspector for every 11 farmers but one for every 370 patients in nursing homes.

We must put in a properly-staffed inspectorate. Taking on board what Senator O'Toole said, we must put in place the right people from the various disciplines, such as nursing, health and safety and others, who will go into homes unannounced on a regular basis and report on the work being done.

I commend Senator White on her document. I only glanced at it today but believe she is making a genuine attempt to highlight the problem. Most elderly people want to stay and receive care in their homes for as long as is humanly possible. That should be our aim, as has been stated in all Government policies since 1999 and long before in various health reports. We are not putting sufficient effort into home care packages to assist people who live at home and want to stay there. We are not giving sufficient support to the carers in our society, who are unsung heroes. These people deserve far greater support than they have received.

We should also consider sheltered housing for the elderly. Many are ambulant and can get around but are fearful for their safety in their own homes, as are their families. There should be more sheltered housing with facilities providing all the supports the elderly need. We should support facilities such as that in Mulranny and other areas.

This report is damning of our society and of the inaction of all the people involved in this debacle. Let us hope the Government acts this time because in 2001 it was fully informed of the situation. A full and frank debate took place in this House and commitments were given which were not honoured. If commitments at that time had been honoured we would probably not have had a Leas Cross or the other problems with nursing homes that have been mentioned.

9:00 pm

Photo of Paul BradfordPaul Bradford (Fine Gael)
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I am glad to have the opportunity to contribute to this debate. I welcome the fact it is taking place because it helps bring further into the open the dreadful difficulties at Leas Cross. It must cause us to reflect on the possibility that Leas Cross was not alone in the difficulties it faced and it puts a strong moral obligation on the Government not just to investigate individual cases but to ensure a full and positive response.

An inspectorate is vital. We must ensure all institutions which care for the elderly, be they private residential homes or public district hospitals, offer the highest standards of accommodation possible. The people who reside at such places must be given all the attention they require and an inspectorate must ensure that happens.

I support the concluding comments of Senator Cummins on assisting the elderly to remain in their homes for as long as possible, which should be central to any debate we hold on the elderly. I also welcome the work done by Senator White in publishing her proposals. It is interesting that the Senator has brought forward two policy papers, one dealing with child care, the other with care of the elderly. We have debated child care much in the past couple of years and some progress has been made, though there is a long way to go. We have not, however, matched that debate at the other end of the spectrum with an equivalent one on care for the elderly and the ageing process, and how to plan ahead in that context.

It depresses me that the only solution we seem able to find is nursing homes. If as a society the extent of our ambition for the elderly is that they have a perfectly clean and comfortable bed in a clean and comfortable nursing home or district hospital, fully regulated and open to inspection with all medical support available, we have many questions to answer. We must revert to attempting to ensure the maximum number of citizens can remain with their families and in their communities. That should be our ambition for the elderly.

Consider the demographics of the country. The population is ageing; people can now aspire to living longer than was the case heretofore. While this gives rise to certain difficulties, it also creates opportunities. It is a question of what our political and social ambitions for the elderly are. Whether it is Leas Cross, another private nursing home or a district hospital in which people reside when no other option is available, we must ensure the accommodation is of the highest standard. However, it is only a partial answer to what we as a society and particularly as Members of the Oireachtas owe to the elderly, the people who built this country.

A great deal could be done. I hope in the budget next week there will be further progress on ways to ensure people can remain with their family and friends in their community. The carer's allowance scheme is one which, if amended slightly and at modest cost, could help many more to remain in their homes. We have debated this issue previously with the Minister for Social and Family Affairs, Deputy Brennan. From the figures he provided in the course of the debate on social welfare matters last year it appears that the cost of removing the means test and providing the maximum carer's allowance for those providing full-time care and attention for those in need of it would be modest in the context of overall social welfare provision. I hope there will be progress in that regard.

Senator Cummins mentioned sheltered care residential units, about which a great deal more could be done. There are tax breaks and investment allowances on construction of all types, from holiday homes to car parks to student accommodation. It would be valid to bring forward tax relief proposals for the construction of residential care units for the elderly in towns and villages where people could live independently but with a certain level of care available. More money should be provided for grant schemes such as the disabled person's grant scheme. Planning policy should be examined in order that where people are seeking to build a granny flat or a suitable alternative unit of accommodation near their family home for an elderly relative, it would be considered a welcome development rather than a planning difficulty. These suggestions should be considered seriously.

Having perfect nursing homes and district hospitals, while that is necessary and should be an aspiration, is far from the complete answer to what society should attempt to provide for the elderly. It is a challenge. The demographics of our society have changed to the extent that the magazine Ageing Matters states that by 2050 Irish people older than 65 years will outnumber those under 16. That statistic brings opportunities and challenges but it also shows the scale of the task we face. It must confirm the fact that the nursing home solution, as a stand-alone solution to care of the elderly, is well off target. The political challenge is to seek to support every effort that will allow people to remain in their community, whether that is by way of grant aid, tax initiatives or support through the various social welfare schemes. That is best for the elderly and their families and, in the long run, society.

Nursing homes, be they private nursing homes or public district hospitals, will continue to play a role in care of the elderly. We must ensure the highest standard of care and accommodation is provided. The Leas Cross report is a wake up call. There is also the issue of profiting from investment in nursing homes. We read about consortia and various groups reflecting on the possibility of buying chains of nursing homes in Britain or Ireland and reports in which the elderly are described as a growing market, as if they were an economic prospect for financial gain. That is worrying. If that is how we see the issue, this has become a very cold society.

The challenge starts in the budget next week and the measures the Minister for Finance and the Minister for Social and Family Affairs put in place to provide for the elderly. As we have a booming economy, sufficient resources must be provided to care for them. They are more than the grey vote; they are not simply units of the electorate or the economy. They are the people who built this country and deserve a great deal more than they have received from Governments during the years.

Photo of Seán PowerSeán Power (Minister of State, Department of Health and Children; Kildare South, Fianna Fail)
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I welcome the opportunity to respond to the issues raised in this debate. I thank Senators for their contributions. Many important issues were raised, with Senators viewing the issue from the background of their own experience and some from the perspective of the careers they had before becoming Members of the House.

Senator O'Toole spoke about the publication of the report and the difficulty that arose about the legal concerns expressed by the HSE at the time. He did not consider these to be real concerns. As the HSE had commissioned the report, it was its property. It raised this difficulty at an early stage. The problem was that people were mentioned in the report, probably in a critical fashion, and not given an opportunity to respond. That was probably due to the terms of reference given to Professor Des O'Neill. However, that is not meant as a criticism of the report. The Minister indicated that whatever legal issues had arisen should be overcome, as we were keen to have the report published. It is clear from the final report that the people and organisations mentioned in it, directly or indirectly, were given an opportunity to respond, as their responses are included.

One of the comments made in the report by Professor O'Neill is that what happened in the nursing home equates to institutional elder abuse. Efforts are ongoing within my Department to deal with instances of elder abuse and to improve and develop services for older people. Following the publication of the report, Abuse, Neglect and Mistreatment of Older People: An Exploratory Study, by the National Council on Ageing and Older People in 1998, a working group was established to advise on the formulation of procedures and guidelines on elder abuse. The working group published its report, Protecting Our Future, in 2002 after carrying out a comprehensive work programme.

While the prevalence of elder abuse in Ireland is not known, studies in other developed countries indicate that about 3% to 5% of older people living in the community may suffer abuse at any specific time, which implies that between 12,000 and 20,000 people living in the community in Ireland may be suffering from abuse. There are no figures available on the incidence of abuse in institutions but, unfortunately, such abuse does occur. While we are concentrating in this debate on the abuse which took place in one nursing home, the majority of abuse occurs in older people's homes.

Protecting Our Future recommended that the issue of elder abuse should be placed in the wider context of health and social care services for older people. Elder abuse is a complex and difficult issue to define precisely. It may involve financial, physical or sexual abuse or it may arise due to inadequacy of care. The report made recommendations on health services structures, awareness, education and training, financial abuse, advocacy, legislation and research and education, which would include the establishment of a national centre. It also recommended that an elder abuse national implementation group should be established to guide the implementation of the recommendations outlined in the report. Such a group was established under the chairmanship of Professor Desmond O'Neill, a consultant in the medicine of old age, in December 2003.

Awareness training for Health Service Executive staff has been provided in line with the report and the HSE has been involved in awareness training with volunteer staff, including the national senior citizens helpline. The issue of elder abuse is being incorporated into professional training courses in areas such as gerontology. In addition, a number of research projects have been undertaken, including the examination and review of medication for older persons in continuing care settings. The Health Service Executive recently advertised for senior case workers and it is expected that 27 such workers and four dedicated elder abuse officers will be appointed by the end of the year. Discussions are ongoing on the structure of a new research centre for elder abuse and work continues on the preparation of a tender document for the new facility. In the period 2003 to 2005, approximately €2.5 million in additional funding was allocated to the elder abuse programme and €2 million was allocated in the 2006 budget to facilitate the implementation of the full range of recommendations in this area.

The cornerstone of Government policy in the care of older people is to support and maintain people in their home environment, whether that be the family home, a community residence or a residential centre, assist those who become ill or dependent to regain their independence where possible, encourage and support care in the community and provide a higher quality of hospital care when people can no longer be maintained in dignity and independence at home. With regard to Senator Bradford's comments on nursing homes, our aim is to provide as much care as possible at home so that nursing homes are the last option rather than the first.

I acknowledge the significant investment made by this Government in the care of older people and palliative care, as represented by the additional €110 million announced in the budget for 2006 by the Minister for Health and Children, Deputy Harney. The full year cost of the services outlined in this package is €150 million. The Minister for Finance has indicated that older people will be one of his priorities in this year's budget. While I would be first to acknowledge that services for older people were under-funded for a long time, a serious attempt was made last year to address that imbalance. The €150 million allocated last year represents the start of a major investment programme in services for older people.

Home care packages deliver a wide range of services and, in recent years, have been piloted successfully in several regions. Such packages include the services of nurses, home care attendants, home helps, physiotherapists and occupational therapists. Last year, approximately 1,100 home care packages were provided and we are in a position to provide an additional 2,000 packages this year. The HSE has informed the Department that a total of 3,095 additional home care packages were provided up to the end of September 2006. Not only can home care packages keep people out of hospitals and nursing homes but they can also facilitate early discharge of patients. Patients and their families have thus far been very appreciative of the supports on offer.

Home help services are an essential part of supporting older people at home, serving to delay or prevent admissions to long stay residential care. They also help to keep people out of acute hospitals and support early discharge. An additional €33 million full-year cost was allocated for this programme under the 2006 budget. This funding is being used to provide 1.75 million more home help hours this year.

Day and respite care are an integral part of delivering a comprehensive community service for older people. The provision of €9 million in a full year allows for an additional 1,325 places per week in such centres.

There is a significant increase in the resources available to meals on wheels services. Apart from the nourishment provided through these services, they also offer social contact to people who would otherwise be very lonely.

Senator Cummins referred to the need to provide more resources for sheltered housing projects. One such project is the Nás na Riogh Housing Association, which is converting an old convent into units for older people and facilities for intergenerational community activities. The building, which is located in the heart of Naas, will provide opportunities for younger and older people to mix on a daily basis. Some older people encounter a lack of stimulation when they enter homes and go downhill very quickly as a result. Although it will not be complete for some time to come, the Nás na Riogh Housing Association project will be a model which can be replicated throughout the country.

It is clear from the 2006 budget package that the Government is firmly committed to developing services for older people. The emphasis on developing home care packages and the increases in the home help and meals on wheels schemes and other community-based supports are assisting older people to remain in their own homes and communities for longer, in accordance with their wishes. In addition, extra funding has been provided to the nursing home subvention scheme to support the increasing numbers of people who are entitled to subvention and to reduce waiting lists for enhanced subvention.

The Health (Nursing Homes)(Amendment) Bill 2006, which addresses the issue of subvention schemes, is being debated in the Dáil. While I would be the first to admit that inadequacies exist in that area, the Government is actively considering funding for long-term care to address the challenges faced by older people and their families. Tough decisions will have to be taken but we will not avoid them.

It is right that we should devote substantial additional resources to services for older people. Older people have made a great contribution to our society and to our present economic and social success. Through our investments, we are saying that younger generations value the contributions made by older people and respect their needs and continuing role in society.

Photo of Paddy BurkePaddy Burke (Fine Gael)
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When is it proposed to sit again?

Photo of Pat MoylanPat Moylan (Fianna Fail)
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Tomorrow at 10.30 a.m.