John Paul Phelan (Fine Gael)
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I welcome the Minister of State, Deputy Cuffe. It is not a personal attack on him, but when I put down an Adjournment motion and there is not a Minister from the relevant Department present, I always place on record that one should be here. I have never been involved in a debate with Minister of State, Deputy Cuffe, and I hope he will have positive news for me on this issue.

It concerns the fallout from a number of scandals in private nursing homes across the country. The State correctly took a decision to introduce standards of care for patients in both public and private nursing homes across the State and the Health Information and Quality Authority, HIQA, is the body that is responsible for implementing these standards. Everybody accepts they are necessary and that nursing homes, be they private or public, should have minimum standards of care for their patients.

The reason for this motion is that there is another group of facilities which cater for older persons and which are not nursing homes, but which provide a form of sheltered accommodation, and these are called supported care homes. No provision has been made, as I understand it, in the legislation or regulations dealing with nursing homes for this category. There is a number of them around the country. There is a concentration of them in Kilkenny because the late Dr. Peter Birch, as Bishop of Ossory, was a forward-thinking man in the early 1980s and he donated much church property to local communities, and these supported care homes were developed in those communities.

My difficulty, and the difficulty that these facilities are having at present, is that the HIQA standards for nursing homes are being applied to these supported care homes. The difference is that nursing homes require 24-hour nursing care to be available for patients. Most of the residents - they are not patients - in the supported care homes live independently. Most of them leave the homes during the daytime, go to the shop, to the post office, mix with their friends and go for a drink, but they are not capable of independent living for one reason or another, and they get meals provided communally every day. Indeed, in many such homes, at least in Kilkenny, other elderly persons in the community come into the facilities for the provision of services during the daytime.

The difficulty is that these particular homes are faced with a stark situation at present. They will either have to double, or possibly increase even further than that, the charges to their residents or some of them will have to consider the possibility of closure. Between the five homes in Kilkenny of which I speak, namely the O'Gorman Home in Ballyragget, Prague House, Freshford, Mount Carmel of Callan, St. Joseph's, Kilmaganny and Gahan House in Graighnamanagh, there are over 100 full-time residents, but they cater for a much larger number of people who come in for day-care facilities and services. If these homes are forced to close, obviously, it will be a considerable loss to the local communities concerned.

I hope the Minister of State will be able to provide clarification. I have sought direction from the Department of Health and Children on this issue over the past few months and I have not got a satisfactory answer.

I thank the Cathaoirleach for taking my Adjournment motion concerning these fantastic facilities. In many instances, much of the work that goes into these facilities is voluntary. They raise much of the funding independently through local fund-raising efforts.

What they really want is not no standards because they accept there must be standards for them, but that account be taken that they do not provide 24-hour nursing care. If a resident becomes ill, he or she goes to the acute hospital or goes to a nursing home, be it public or private. If they require that level of care and support, they leave this sheltered accommodation. They want standards that are suitable for the type of care these institutions provide.

Ciarán Cuffe (Dún Laoghaire, Green Party)
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I am taking this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible and to support access to quality long-term residential care where this is appropriate. The Government places great importance on the policies and practical reforms we are implementing to ensure patient safety and quality-assured health services.

The Minister assumes the issue the Senator is referring to is the registration and inspection regime in respect of designated centres for older people, or nursing homes.

It is important to have effective mechanisms to maintain and enhance public confidence in the delivery of quality residential care. Residents, their families and the public need to be reassured that the authority is monitoring the care people receive. The Health Act 2007 provides this, with a regime designed to protect the public through an independent inspection and registration system for residential services. The primary legislation also defines what is a designated centre, and this includes an institution at which residential services are provided.

On 1 July 2009, statutory responsibility was given to the chief inspector of social services, part of the Health Information and Quality Authority, for inspecting and registering nursing homes. This responsibility is underpinned by a comprehensive quality framework comprising the Health Act 2007, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 and the National Quality Standards for Residential Care Settings for Older People in Ireland.

Over the past year the system, nature, frequency and duration of inspections have changed. Some homes may receive just one inspection a year, others may have four or five, depending on risk analysis and their previous inspection history. The formal inspections may also last a number of days. HIQA has advised the Department of Health and Children that between 1 July 2009 and 28 May 2010, it carried out 548 inspections covering 371 centres.

The standards themselves acknowledge the unique and complex needs of the individual person at the centre of care, and require service providers to deliver a person-centred and comprehensive service that promotes health, well-being and quality of life. They are about much more than infrastructure. They are patient-centred, providing a blueprint for the provision of a higher standard of care delivered against a set of understood and developed criteria, designed to improve and enhance care and to recognise good practice. They are evidence based, and identify whether the best services possible are being delivered in an effective and appropriate way.

National standards are set by HIQA and under section 10 of the Health Act 2007, it is required to submit proposed standards for the Minister for Health and Children for approval. She approved the current ones on 17 February 2009. The authority has confirmed it will not be reviewing them in 2010. However, it is intended that the Department of Health and Children will commence a review of the care and welfare regulations later this year.

All nursing homes for older people are subject to the same core standards on quality and safety. The Minister is sure the Senator will agree lessons had to be learned from the well publicised incidents in nursing homes over the last few years and from reports such as that of the Leas Cross commission of investigation, published just last year. This new system of regulation and inspection is to underpin quality and safety for residents in nursing homes.

The Minister reassures the House that the residents are our primary concern. Quality care and patient safety come first with all residents receiving the same high standard of quality-assured care. It is my hope the progress we have made will reassure older people and their families that high quality care is available and will make the transition from independent living a less daunting prospect.

I take the opportunity to thank the staff of the Seanad and everyone involved in the running of the Houses for all their care and work during the year and wish everyone the best for the summer recess.

John Paul Phelan (Fine Gael)
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I have been here for eight years and, for whatever reason, this is the fourth, if not the fifth, year in which I have had the last Adjournment matter on the last sitting day. It has been a long term and most people are looking forward to the break. I wish the Leas-Chathaoirleach, the Minister of State and the staff of the Houses a good break in the coming weeks.

Paddy Burke (Fine Gael)
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I wish to be associated with the wishes of the Minister of State and Senator Phelan for a good, long holiday.

Ciarán Cuffe (Dún Laoghaire, Green Party)
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I am unsure about that: our work will continue.