Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 240: To ask the Tánaiste and Minister for Health and Children the discussions she has had with the Health Services Executive regarding the Leas Cross nursing home, including an assessment of the decision to move residents from the home; and if she will make a statement on the matter. [24429/05]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 241: To ask the Tánaiste and Minister for Health and Children if her Department has put in place and implemented a strategy, or a revised strategy, with regard to supervision and management of private nursing homes for older persons in view of the Leas Cross scandal; if so, if this strategy includes a provision that older persons should not be moved from homes when this is avoidable, including through State agencies taking over the management of these homes; and if she will make a statement on the matter. [24430/05]

Seán Power (Kildare South, Fianna Fail)
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I propose to take Questions Nos. 240 and 241 together.

The Department of Health and Children asked the Health Service Executive for a report on the matter raised by the Deputy. The executive has informed the Department that the nursing home inspectorate in the HSE northern area had concerns about the number of high dependent residents in Leas Cross, the unsatisfactory level of staffing, the skill mix among staff, the lack of care planning and the level of complaints. The HSE contacted the management of Leas Cross in late 2004 and early 2005 to ask it to deal satisfactorily with such matters. The Deputy is aware that the RTE "Prime Time" programme about Leas Cross, which was broadcast on 30 May last, highlighted highly unsatisfactory care issues in the nursing home.

The HSE has advised the Department that prior to the programme being broadcast and immediately afterwards, senior management within the HSE northern area had a series of meetings with the management of Leas Cross. The meetings culminated in the HSE northern area assigning a director of nursing and senior nurse management to Leas Cross from 1 June. The director was charged with ensuring patient safety, improving the level of care in the home and providing training and support to suitable skilled staff, after they had been recruited. The director of nursing and her staff were very concerned by 8 June with the exceptionally low level of care throughout the home. The care was being delivered, in the main, by unskilled staff and a small number of nursing staff. Of particular concern were the staffing skill mix, the proportion of unqualified staff, infection control, record keeping and fire safety were issues of particular concern in so far as they impacted on patient care and safety.

The HSE has informed the Department that management personnel at Leas Cross were advised by the HSE of the additional numbers of appropriately skilled staff required to meet the care needs of the residents at Leas Cross. The management of Leas Cross advised it was not in a position to source and recruit such numbers of staff. The management was formally advised on 15 June that the HSE needed to fulfil its duty of care and obligations to the residents of Leas Cross immediately. In this context, it was necessary to make alternative arrangements for the provision of care to patients placed in Leas Cross by the HSE, as well as patients receiving subvention from the HSE who were resident in the nursing home. Following that decision, a programme was put in place by the HSE. The programme involved consultation with the residents of Leas Cross and their families; counselling and support for the residents, their families and the staff of Leas Cross; sourcing and quality-assuring alternative nursing home places and presenting residents and their families with accessible alternative nursing home options; facilitating visits by families and residents to various homes, as well as facilitating patient assessments; arranging clinical assessments of all patients; and managing and supporting the transfer of residents individually to their nursing home of choice.

On 6 July 2005, the management of Leas Cross formally advised the HSE of its intention to close its nursing home as and from 1 August. The transfer of residents to their new homes took place on a phased basis, with a small number of residents moving each day. The transfers were carried out in this manner so that each resident and his or her family would have the necessary level of support from HSE staff in moving from Leas Cross and in settling into a new home. To this end, a number of experienced administrative staff were assigned to support the director of nursing. The deadline set by the management of Leas Cross was met and the final residents transferred to their new homes on 30 July. Communication is ongoing between the HSE and the management of Leas Cross about the removal of Leas Cross from the register of nursing homes. The HSE has informed the Department that it has appointed a professor of geriatric medicine to review independently the deaths at Leas Cross. This process is ongoing and the review should be available by the end of the year.

In light of recent events, the HSE is reviewing all matters relating to private nursing homes including the inspection process and the standards of care. The HSE is working in a consultative manner with private nursing home organisations to improve the overall standards of care in private nursing homes. The HSE's policy is that patients are not moved from one nursing home to another except in the interests of patient safety and when all other options have been exhausted. In this event, the HSE can take over a nursing home following mutual agreement and/or a court order.