Deputy Yates was in possession.
Private Members' Business. - Health (Nursing Homes) Bill, 1989: Report Stage (Resumed) and Fifth Stage.
Debate resumed on amendment No. 19:
In page 7, lines 37 and 38, to delete "and the person in charge of the home".
—(Deputy Yates)
Before we adjourned I was expressing my concern about having the person in charge registered completely separately from the proprietor. I certainly intend to press the matter. On Report Stage we cannot have an exchnage of views but I would like to ask the Minister about the register and if it is his intention that on the register of proprietors there would be a reference as to whom the person in charge might be; how interchangeable that is; the regulations that will apply in relation to it. Perhaps the Minister could clarify those points.
I will permit a brief reply.
It is the intention that the health board will know at all times who is in charge in the nursing home.
Amendment put and declared lost.
I move amendment No. 20:
In page 7, line 41, to delete "the District Court" and substitute "The Minister for Health".
This amendment proposes that the Minister for Health as opposed to the District Court would deal with appeals. We discussed this matter at some length last week and I would like to ask the Minister if he has given any further consideration to bringing uniformity into the code of appeals by giving the Minister for Health this role. People concerned are not used to appearing in court, which involves expense, delays and uncertainty, and I would ask the Minister to reconsider this matter.
I gave my view on this matter on Committee Stage. I am not disposed to supporting Deputy Yates's amendment and I gave my reasons then.
As I stated on Committee Stage, this role is more appropriate to the District Court. The fact that it is the District Court that would be involved would ensure that the health boards would be particularly objective in reaching their decision because they certainly would not want to go into the District Court to fight a case unless it was absolutely necessary.
I am disappointed with the Minister's response, but I accept that the case is lost. I hope the Minister will ensure that there is consistency in relation to the appeals process. I withdraw the amendment.
Amendment, by leave, withdrawn.
Amendments Nos. 21 and 22 not moved.
I move amendment No. 25:
In page 8, line 13, after "notification" to insert "the nursing home shall be treated as if the decision had not been made and, if the decision was to refuse an application under paragraph (a) of section 4 (12) for registration, be treated as if it had been registered and the registration had attached to it any conditions attached to the relevant registration that had ceased by virtue of subparagraph (i) of the said paragraph (a),".
This is a drafting change to clarify the position of a nursing home which a health board has decided not to register or reregister and which does not lodge an appeal against the decision. Under this section a health board will be able to specify a phasing out period in which alternative arrangements can be made for the patients. A health board cannot specify a date that is less than 21 days from the date of decision, as this is the time allowed to a nursing home owner to lodge an appeal.
I have no objection to this amendment.
The points we made on Committee Stage in relation to the clarity of this section have been taken into account in the drafting of this amendment, and I welcome it.
I agree with the amendment.
Amendment agreed to.
I move amendment No. 24:
In page 8, lines 18 to 20, to delete "to the Circuit Court under subsection (3) or any appeal from the determination of that Court" and to substitute "or from any such appeal".
This is also a drafting amendment, consequent on the acceptance of an amendment to subsection (3) on Committee Stage. Subsection (3) no longer refers to the Circuit Court.
Amendment agreed to.
I move amendment No. 25:
In page 8, line 23, to delete "concerned".
This is also a drafting change suggested by the parliamentary draftsman.
Can the Minister explain a little further why he wants to delete this word?
The provision will now read "the nursing home shall", and the word "concerned" is deleted.
Why is it proposed to delete it?
The draftsman made that suggestion on the basis that the word "concerned" was superfluous.
Amendment agreed to.
I move amendment No. 26:
In page 8, line 41, after "homes." to insert "The Minister may consult with relevant caring and professional organisations in the preparation of these regulations.".
The Minister said last week that this amendment is unnecessary. While that may be the case now by virtue of the fact that there has been consultation on the present regulations, I would like to copperfasten the legislation so that in the future if there is a major change in the regulations, which would not have to come before this House, there be an opportunity for consultation.
I put down a similar amendment on Committee Stage and the Minister's reasoning then was that the regulations already had been drawn up and that extensive views were sought in the drafting of the regulations. Perhaps the regulations will stand the test of time and will never need to be amended but this is a safeguard that I would support. It is a very desirable objective that all concerned would be consulted and have their views taken into account and it is important that that principle be enshrined in the legislation, even if it was never to be used. As the principle already has been accepted by the Minister and indeed used in the drawing up of the draft regulations which will become operable once this Bill is passed, I do not see why the Minister would not accept the amendment proposed by Deputy Yates.
While I have sympathy with Deputy Yates's amendment, it is rather meaningless because it uses the word "may" rather than "shall". With respect to Deputy Yates, it could hardly be maintained that the Minister would not consult with relevant, caring and professional organisations. In other words, if this amendment is not adopted and if the Minister decided — I hope he will do so to consult with the relevant caring and professional organisations before making the regulations, I do not think anyone could come along afterwards and say he is not empowered by the Bill to consult. If the amendment is to have any force, the word "shall" would have to be used instead of the word "may".
Earlier in the debate this evening the Minister quoted from the Irish Private Nursing Homes Association and referred to the fact that consultation had taken place. The amendment is reasonable and I support it.
On this occasion and indeed on the occasion of the 1985 regulations a number of organisations, including the health boards, the Irish Private Nursing Homes Association, the Irish Nurses Organisation and the Conference of Major Religious Superiors, were consulted and their views were taken into account in finalising the draft regulations. As Deputy Garland has pointed out, if the word "may" is inserted it would not commit the Minister of the day to consult. It just says he may do that. In the past, Ministers have always consulted and I am satisfied that they will continue to do so. After all, this is non-contentious legislation in which we want to do the very best we can for the people in nursing homes. I am satisfied that Ministers will consult with the appropriate organisations.
The Minister cannot give a commitment in relation to future Ministers because he will have no control over the situation. In order to safeguard the interests of these relevant organisations who feel vulnerable in relation to changing regulations, the question should be put.
Question "That the amendment be made", put and declared lost.
I move amendment No. 27:
In page 8, between lines 46 and 47, to insert the following:
"(b) prescribe requirements as to the maximum fees which may be charged for the care of dependent persons while being maintained in a nursing home,".
Having considered the matter very carefully and following a lot of consultation, I thought it necessary to resubmit this amendment. On the last occasion I made reference to sections 26 and 54 of the Health Act, 1970. If that is to be the criterion by which the provision is made then it is very vague. Section 26 (1) states:
A health board may, in accordance with conditions (which may include provision for superannuation) as may be specified by the Minister, make and carry out an arrangement with a person or body to provide services under the Health Acts, 1947 to 1970, for persons eligible for such services.
Indeed, section 54 does not clarify the position to any greater extent. It states:
A person entitled to avail himself of in-patient services under section 52 or the parent of a child entitled to allow the child to avail himself of such services may if the person or parent so desires, instead of accepting services made available by the health board, arrange for the like services being provided for the person or the child in any hospital or home approved of by the Minister for the purposes of this section, and where a person or parent so arranges, the health board shall, in accordance with regulations made by the Minister with the consent of the Minister for Finance, make in respect of the services so provided the prescribed payment.
At present the subvention varies in my constituency of Cork. I am aware that the Minister has in his possession representations from the public relations officer for the Cork Association of Nursing Homes. He has written because of the fact that there was a difference in the amounts paid to institutions providing a service in the Cork area. Unless the subvention is stated clearly as to what the maximum fees might be there could well be a situation where the standard of service being provided would be lower. At present there is much concern regarding the inadequate subvention and that that would result in homes lowering standards. The current level of subvention ranges between £45 and £54 per week. The State pension brings the average elderly person's income up to £95 per week and the families must pay the difference. On the last occasion I emphasised very strongly that families cannot afford to pay. Following the enactment of this legislation private nursing homes will be providing for people with full eligibility. It is desirable and it is imperative that the fees being laid down should be prescribed in the Bill.
I support the amendment in the name of Deputy Sherlock. It impinges on a crucial aspect of the Bill which is the only aspect that will remain unsatisfactory once this Bill passes through Report Stage — that is the whole area of support for people in nursing homes. We will deal with that specifically when we reach section 7 but, unfortunately, any effort we make to provide adequately for dependent people will, no doubt, be ruled out of order, as happened on Committee Stage on the basis that our Amendments would constitute a charge on the State. At least, the amendment before us allows us in a circuitous way to comment on this issue, which will be the core of the Bill. There is no use having first rate, grade one quality nursing homes that simply are not available to people who need them because of finances. The amendment envisages that it would be possible under the regulations to prescribe requirements regarding the maximum fees which may be charged for the care of dependent persons. That would allow some control over the operation of nursing homes as commercial undertakings. If I recall correctly, the Minister's attitude on Committee Stage was that there should not be public interference with what is a commercial activity. This type of commercial activity dovetails so critically into the overall care provision of the State that fundamentally the State and, indeed, the Minister for Health has a responsibility to provide for the care of elderly people whether they are in nursing homes, boarded out or in geriatric hospitals or wherever. I do not think the Minister can simply abandon any group even if they are not under the direct care of the State. The whole reasoning behind this Bill is to provide an adequate framework in terms of quality for the private sector nursing homes. We should examine the fees aspect as well so that the private sector cannot overcharge for private care and that the State would have some direct role in determining what is fair and reasonable in this regard. For those reasons I hope the Minister will consider favourably the amendment put forward.
I profoundly disagree with this amendment and the whole philosophical basis on which it is being put. The fact is that it is adding a layer of bureaucracy and there is enough bureaucracy in this Bill. It is nonsense. This is an effort at levelling down, not levelling up. If a nursing home wishes to make a substantial charge to those wealthy people who can afford to pay it, so be it. I would be totally opposed to this amendment.
I disagree with Deputy Garland. If someone is in a nursing home for a number of years they can become a captive consumer. They may have established a dependency on that nursing home. I would not like to see anybody subjected to over-charging. At a minimum I would like to see stated in the regulations the possible maximum fee that might be charged. There should not be elaborate policing mechanisms but there should be some check and balance on the system so that people would not be ripped off and over-charged. In those circumstances I support amendment No. 27.
The Deputy has changed his tune since the last day.
The Deputy's memory, and not what I said, is causing difficulties.
That is not what he said——
The Deputy will learn when he is in contact with the people.
As I said on Committee Stage, I do not think it would be appropriate to lay down in legislation the fees which a private nursing home may charge. My own view is that the market is and will be the regulator of nursing home fees. I do not believe there will be a monopoly. There will be a number of homes, as there is already in Dublin and throughout the country, in business. Resolutions such as this could be detrimental to the future of nursing home care. The position will be monitored in that the health boards will be making a subvention to the nursing homes and will obviously be interested in what they are charging. That is something that can always be kept under review by way of regulation. It would not be appropriate to have it enshrined in the Bill.
The Minister on this occasion is acting as if the Dáil is deliberating and will enact legislation which has to do with private nursing homes that will cater for people who can afford it. The Minister is wrong in that and will be proved wrong because experience shows that more and more nowadays the health boards have to rely on the availability of beds in private nursing homes. The question of subvention will be very much part of that and consequently the fees charged will have a bearing on what subvention is paid.
Is there any reason the Minister should not agree to prescribe the fees which may be charged for the care of a dependent person for whom accommodation is sought in a private nursing home? As I have said ad nauseam, the reason there has been an increase in the number of private nursing homes is that during the past four or five years the State has failed to provide an adequate number of beds. Indeed, the number of beds available has been reduced, and drastically reduced in certain areas. Because of this families have been put under great strain. We should not forget also that many old people fear what is going to happen to them and are wondering if their families will be able to afford to pay for accommodation for them. In many cases they will not be able to. As a result, this fear in the minds of the elderly may send them to an early grave.
It is unfortunate that a person with such a fear may be told, having been recommended by a health board geriatrician, that they have to wait for between eight and 12 months before they get a bed. In the case of a person who needs care and attention above and beyond what can be provided by their own family, the family may have no option but to seek accommodation for them in a private nursing home. It is both desirable and imperative that the Minister prescribe in the legislation the fees which may be charged, as that is the only way to settle the matter.
Amendment put and declared lost.
We now proceed to amendment No. 28 in the names of Deputies Sherlock and Garland. Amendments Nos. 41 and 44 are alternatives and amendment No. 40 is consequential on amendment No. 41. I suggest, therefore, that we discuss amendments Nos. 28, 40, 41 and 44 together by agreement with separate decisions, if required. Is that agreed? Agreed.
I move amendment No. 28:
In page 9, between lines 2 and 3, to insert the following:
"(c) prescribe requirements as to the recreational and therapeutic facilities provided in nursing homes,".
It is only reasonable that we should prescribe requirements for the recreational and therapeutic facilities provided in nursing homes. Facilities should be provided and any legislation which fails to prescribe such requirements falls far short of what is required.
I would like to point out that I am not getting on somebody's back for a free ride in putting my name after Deputy Sherlock's. I tabled a similar amendment on Committee Stage but on reflection I considered that Deputy Sherlock's amendment was superior and I now go along with his. I do not think anything more needs to be said on the subject other than that I commend the amendment to the House.
Section 6 is the most important section in the Bill in that it lays down regulations aimed at the protection of the elderly. However, I feel there is one omission and that is that the section fails to acknowledge that the quality of an elderly person's life depends not only on the quality of the residential care provided but also on the provision of services, such as chiropody and physiotherapy services, dental care and ophthalmic care and so on, by the home or in conjunction with the health board. The arrangements made for elderly people in public beds should be the same as those made for those in private nursing homes who fall under category 1. There should be an obligation on health boards and private nursing homes to provide such facilities as they greatly improve the quality of life for the elderly and complement the services already being provided. We should not insist that the nursing home should have to provide these services on their own but there should be access to these services. We should not put people into nursing homes and then forget about them. We must pay attention to the quality of their lives, which depends to a great degree on the provision of these ancillary services.
What I am suggesting is not all that different from Deputy Sherlock's amendment which relates to therapeutic facilities. Because of this I would have no objection to the inclusion of amendment No. 28. In relation to the Minister's amendment, I do not think it meets the need for extra services and I would like him to inform us what is the purpose behind the inclusion of the words "at the option of such owners". It would seem that the provision of such services should not be optional for the owners of nursing homes.
We discussed this matter on Committee Stage. As Deputy Yates said, we should ensure that the legislation is as comprehensive as possible to protect the interests of old people in private nursing homes. The Minister has gone a long way towards achieving this but a glaring gap was highlighted on Committee Stage in relation to the therapeutic and health facilities which are required for elderly people. The Minister may feel that a private nursing home is not a health board institution and therefore they should not be required to provide these vitally important support services for the residents. It needs to be recognised however, that not only should there be requirements as to the quality of food, bedding and open space, there should also be requirements as to ancillary medical support services such as chiropody and ophthalmic care. People being cared for in private nursing homes should have access to such facilities as of right. The argument is a very strong one and I fail to understand why the Minister, who has so generously accepted so many other arguments made by this side of the House on other sections, has not taken this one on board. It is extremely important that he should do so.
On Second Stage I argued strongly in favour of monitoring the ethos of nursing homes. There are nursing homes who see the taking in of elderly people as, primarily, a commercial or profit-making enterprise, and the ethos of those nursing homes may not be in keeping with the best interests of the elderly people concerned. Like every other Member of this House, I have met elderly people who find it very difficult to complain. Some of these can be very miserable and unhappy in a nursing home where the ethos is not pleasant. If there was regular interaction with a member of a health board, such as a chiropodist, they would have the opportunity to talk and interact with a caring person. While catering for the medical needs of the person, we would also get an overview of or an insight into the ethos of the nursing home. This would be of help in ensuring that people do not end up feeling unhappy. This has happened in the past. For those reasons and given the strength of feeling on this aspect of care for the elderly expressed on Committee Stage, I strongly support the amendment.
I have given a great deal of thought to the points raised by the Deputies on Committee Stage, particularly Deputy Yates's point at that time dealing with services such as physiotherapy, chiropody, dental services and ophthalmic services in nursing homes. I want to meet the Deputies as well as I can on this. My amendment really covers the issues raised by Deputy Yates and by Deputy Howlin here tonight. It goes further because it allows the Minister by regulation to specify the health services which must be available to dependent persons in nursing homes. While I believe the services Deputy Yates is anxious to see included should be available, if we were to write them into the Bill it might well defeat the purpose of the exercise, that is to ensure that whatever range of services are appropriate to the elderly would be available to them. I believe this can be included in the regulations and the 1985 regulations. I commended my predecessor, Deputy Barry Desmond, for the regulations when he was Minister for Health. They were very comprehensive and they indicated the way all parties in this House wish to go to ensure that we maintain a very high standard and high level of care in nursing homes. Those regulations and the new regulation already meet the provisions of the amendment in the names of Deputy Sherlock and Deputy Garland. Those regulations provide that every nursing home shall ensure that facilities are provided for the occupation and recreation of patients. That really deals with the points raised by Deputy Sherlock and Deputy Garland in regard to recreational facilities. It also deals with the need for appropriate medical care by a medical practitioner of the patient's choice or acceptable to the patient. Therefore, the therapeutic needs in terms of the medical needs and the other health service needs are catered for in the amendment I have tabled on Report Stage.
Is the Minister referring to amendment No. 41?
No. 41, yes.
Can he explain his words "at the option of such owners"?
At the option of such owners the health boards may provide the services. For example, the owner might not be in a position to provide a chiropody service but they would be able, in conjunction with the health board, to have the health board provide such a service. That is merely, if a service is to be provided, to ensure that either the nursing home owner or the health board will provide it. It will be at the option of the owner if they are not in a position for very practical reasons to provide it themselves.
The terminology in respect of the health boards concerned is "specified health services". The specified health services will be in the regulations and in my view it is a broader terminology than identifying specific services which may well defeat the purpose of what Deputy Yates, Deputy Howlin, Deputy Sherlock, Deputy Garland and myself want to achieve.
I cannot accept what the Minister stated as indicating in any way a serious intention of making such provision. I am sure the Minister will have got a copy of a report on private nursing homes for the elderly in the Bray area which was issued some time last year. That report says that any form of mental or physical therapy seems to be totally lacking in these homes, with patients being reduced to almost vegetable status, and one visiting doctor stated that in many of the homes absolutely no attention is paid to helping the patients pass the day. More often than not they are left purely to their own devices. That is the kind of situation we want to correct by including this amendment.
The Minister referred continually on Committee Stage and again on Report Stage to regulations. Is he saying the regulations he is talking about are statutory instruments arising from the legislation, or does he propose a statutory instrument that gives legal effect to these matters? His amendment is to insert: "require the provision by the registered owners of nursing homes or, at the option of such owners,". If we are concerned about recreation or the whole range of therapeutic services that might be provided should such a provision be "at the option"? There is a definite need to have a provision as proposed in amendment No. 28. There must be prescribed requirements of recreational and therapeutic facilities. I am pressing my amendment.
I will put the question.
As it is my amendment as well I think I am entitled to speak at this stage.
No, the mover was Deputy Sherlock and only the mover has the right to reply. I am sorry, I cannot facilitate the Deputy now.
Am I not a mover as well?
As these are grouped with other amendments, have I the right of reply on mine? I will be entitled to no word when it comes to amendment No. 44.
Amendments Nos. 28, 40, 41 and 44 were taken together. The mover of amendment No. 28 was Deputy Sherlock. Only he has the right of reply at this stage. When we come to the other amendments questions may be put and were I in the Chair I would allow some question to be put. I would be, shall we say, liberal in the matter but I could not concede to you the right of reply.
Amendment put and declared lost.
I move amendment No. 29:
In page 9, line 11, after "persons", to insert "while being maintained".
This is just a drafting change suggested by the parliamentary draftsman.
Amendment agreed to.
I move amendment No. 30:
In page 9, line 13, after "communications", to insert "by or on behalf of the registered proprietors or the persons in charge of the homes".
Again this is a drafting change recommended by the parliamentary draftsman.
Amendment agreed to.
Amendment No. 31 in the name of the Minister. Amendment No. 37 is related. I suggest, therefore, that we discuss amendments Nos. 31 and 37 together by agreement.
I move amendment No. 31:
In page 9, line 21, before "persons", to insert "dependent".
Similarly these are drafting changes recommended by the parliamentary draftsmen.
Amendment agreed to.
Amendment No. 32 is in the name of Deputy Yates, and amendments Nos. 33, 34, 35 and 36 are alternatives. I suggest, therefore, that those amendments be discussed together. Is that satisfactory?
Agreed.
With separate decisions if requested.
I move amendment No. 32:
In page 9, to delete lines 23 to 25 and substitute "interviews of the patients and staff of a nursing home".
Regulations are to be set out for the holding and conducting of interviews where the health board have reasonable cause to believe that a person in a home is not receiving proper maintenance or care. It is provided that there will be interviews and examinations of dependent persons being maintained in the nursing home. I am all in favour of a thorough investigation but I do not see why it should extend beyond patient and staff. There might be other parties who could be vexatious or could have an axe to grind. These inquiries should be directly related to patients and staff. The amendment more accurately covers what is there already and is a more concise wording. I would ask the Minister to consider this as a tidying-up of the investigation process. I hope he will clearly set out a code of practice to be followed by inspectors. I said earlier that there should be a complaints procedure established so that anyone could have a complaint processed and considered. That was rejected by the Minister but I hope these improvements will be accepted.
A variety of amendments are being taken together. I am not quite certain about the import of the initial amendment. I do not find any difficulty in the Minister's drafting regarding the holding of investigations where there is cause for concern that residents are not receiving proper maintenance or care, or proper medical or other treatment.
My amendment is designed to ensure that residents or staff should have the necessary interviews conducted in private. Representations were made to me on this point by people who deal directly with elderly people in nursing homes. They have expressed the strong view that there are occasions, particularly when complaints are being investigated, when elderly people, who are vulnerable, are intimidated by staff. It must be specified that any interviews or discussions necessitated by an investigation should take place in private. That is a reasonable request.
Deputy Yates refers to interviews of patients and staff. I would dispute whether "patients" is the appropriate word. The two sections of the Minister's draft are comprehensive. If there is to be an investigation anybody who is party to the complaint should have the right of audience. If evidence is required to substantiate the complaint it should be heard in private.
I strongly support Deputy Yates's views regarding the code of practice. It is important that people who are vulnerable, dependent by definition, should have a clear bill of rights that would be easily vindicated without fear of harassment or intimidation. We have to be careful to make sure that those fundamental rights and dignities are afforded people in their old age.
I am not sure what exactly Deputy Yates wishes to see in the Bill or to delete from it. He wants the word "examinations" taken out, which effectively means that a medical officer from the health board would not be in a position to examine a patient or, for example, to see if a person had bed sores.
Regarding Deputy Howlin's amendment, I do not think it is necessary to put in the word "private". It would be a matter for the inspector, a director of community care, to express the view that he wanted to interview a patient and it would be normal to be given the measure of privacy necessary. It is inherent in the present position and if necessary it could be written into the regulations or the code of practice.
I support Deputy Howlin's amendment on privacy. I have no difficulty with the Minister's amendment No. 34. I was originally asked by the Irish Private Nursing Homes' Association to deal with the question of interviews for patients and staff. I will withdraw amendment No. 32 because I have two other amendments about which I feel more strongly.
Amendment, by leave, withdrawn.
I move amendment No. 33:
In page 9, line 23, after "interviews" to insert "(including interviews in private)".
The Minister has no opposition to this amendment but merely feels it is unnecessary. I have had strong representations on this matter from people dealing directly with nursing homes and from trade union groups and others. I would ask the Minister to accept the amendment. It is no burden to specify that interviews should be conducted in private and the Minister has no objection in principle.
I will accept the amendment.
Amendment agreed to.
I move amendment No. 34:
In page 9, line 24, to delete "a nursing home" and substitute "nursing homes".
Amendment agreed to.
I move amendment No. 35:
In page 9, line 25, after "interviews" to insert "(Including interviews in private)".
Amendment agreed to.
I move amendment No. 36:
In page 9, line 25, to delete "a nursing home" and substitute "nursing homes".
Amendment agreed to.
I move amendment No. 37:
In page 9, line 27, to delete "a person in the home is" and subsitute "such dependent persons are".
Amendment agreed to.
Amendments Nos. 38 and 39 may be taken together, by agreement. Agreed.
I move amendment No. 38:
In page 9, line 29, after "inspection" to insert "by two officials of the Health Board".
I have received a submission from the Irish Private Nursing Homes' Association, which states:
A clear, consistent and written protocol of inspection is necessary so that Health Boards and Nursing Home Managements are quite clear as to the demands of legislation and the implication of specific infringements. Providers of such essential services for the elderly require a much clearer understanding of the issues than that which might obtain in relation to pubs, fast food outlets and other leisure facilities.
Basically what is at issue here is the need to have a clearly established legal procedure for investigations and inspections which would be carried out by two health board officials and the establisment of a code of practice so that such investigations and inspections would be carried out uniformly throughout the country. After our debate on Report Stage last week I spoke to some nursing home proprietors who referred to difficutlies they are having with one administrator in a certain health board area. The people who will be dealing with this legislation at the coalface would like these issues to be set out in clearly established and explicit regulations. Amendments Nos. 38 and 39 are important in this respect because they propose the clarification of the procedures in cases where there are disputes. The dictates of justice and fair administration mean that these points should be included in the Bill.
I support amendment No. 38. We had a brief discussion on Committee Stage about the number of officials who should carry out these investigations and inspections. It was felt that two officials would have complementing skills in making a determination and for that reason I support amendment No. 38.
Amendment No. 39 proposes that the Minister should introduce a code of practice for the inspections outlined in this section. It is important for everybody to know the ground rules so that those who are carrying out the inspection — the officials of the health board — will know what is required of them in clear terms and the proprietors of nursing homes will know what is acceptable and what has to be presented. This will be helpful in implementing the legislation because everyone will be clear on what has to be done, the interests of the residents of nursing homes will be protected and the proprietors of nursing homes will know exactly where they stand. In addition it will help health board officials, who will not be obstructed in their duties and who will know exactly their rights and obligations.
I, too, support amendments Nos. 38 and 39. Amendment No. 39 is a follow on from section 6 (2) (i), which provides for the holding of interviews and examinations where the health board concerned "has reasonable cause to believe that a person in the home is not receiving proper maintenance or care or medical or other treatment". It is right and proper in such cases to provide for the carrying out of inspections by two officials of the health board. It is correct to have a standard practice in such cases.
I support amendment No. 38. I am not so sure about amendment No. 39 and I will await the Minister's response to it. This amendment proposes the centralisation of these issues in the Department of Health whereas the philosophy of the Green Party is to decentralise them to the health boards. There may be reasons health boards have different standards. Perhaps the Minister will comment on this point.
The draft code of practice dealing with the implementation of this Bill recommends, where possible, that two persons from the health board should carry out inspections. I believe very strongly that the proposals in amendments Nos. 38 and 39 are best dealt with in the context of the draft code of practice. We have drawn up a draft code of practice which will be available for circulation next week. In addition, a small expert group, which includes representatives of the Irish Private Nursing Homes Association, will meet before the end of this month. I am satisfied that the place to set out how the inspections shall be carried out is in the draft code of practice and not in the Bill at this stage.
In regard to the point raised by Deputy Garland, I think everybody in the House would agree that we want to ensure that nursing homes maintain the highest standards and that these are uniformly enforced throughout the country. The code of practice will ensure the uniform application of this legislation.
The Minister seems to agree with the substance of my amendments. It is important for a code of practice to be established in regard to inspections. I take his point about the two officials, which hopefully will be dealt with by way of regulation. Therefore, I will withdraw amendment No. 38 but will press amendment No. 39.
Amendment, by leave, withdrawn.
I move amendment No. 39:
In page 9, line 35, after "officers" to insert ", and for such inspections as outlined in this section, the Minister shall introduce a Code of Practice to be applied uniformly throughout the country".
Amendment put and declared carried.
I move amendment No. 40:
In page 9, line 39, to delete "and".
Amendment agreed to.
I move amendment No. 41:
In page 9, between lines 39 and 40, to insert the following:
"(1) require the provision by the registered owners of nursing homes or, at the option of such owners, by the health boards concerned of specified health services for dependent persons while being maintained in nursing homes,".
Amendment agreed to.
Amendment No. 42 is consequential on amendment No. 43 and amendment No. 45 is an alternative to amendment No. 43. I propose, therefore, that we discuss amendments Nos. 42, 43 and 45 together. Is that agreed? Agreed.
I move amendment No. 42:
In page 9, line 45, to delete "determine." and substitute "determine, and".
I believe amendment No. 43 meets the purpose of Deputy Yates's amendment No. 45. In the regulations under this Bill we will be obliging nursing homes to make brochures available outlining the services and facilities in each nursing home for prospective patients and their families.
I welcome the Minister's amendment No. 43 which proposes the insertion of a new paragraph (m) in section 6 (2) which will deal with brochures and information. Like other Opposition Deputies, I argued strongly that this information should be available in advance to the elderly people directly concerned and their relatives so that they could make price and care comparisons between different nursing homes. I am glad the Minister accepted this point. On that basis, I will not move amendment No. 45.
I support amendment No. 42 and welcome the fact that the Minister listened to a logical argument on Committee Stage.
Listened, and the Deputy would presume to say, learned his lesson.
I would not be so presumptuous.
Amendment agreed to.
I move amendment No. 43:
In page 9, between lines 45 and 46, to insert the following:
"(m) require the provision of specified information to interested persons by the registered owners or the persons in charge of nursing homes in relation to the homes and the accommodation, services and facilities provided for registered persons while being maintained therein.".
Amendment agreed to.
Amendments Nos. 44 and 45 not moved.
My advice is that as there is a substitute amendment No. 48a in lieu of amendment No. 46 the Minister will not be moving amendment No. 46.
Amendment No. 46 not moved.
Amendment No. 54 is related to amendment No. 47. I suggest, therefore, that we discuss both amendments together. Is that agreed? Agreed.
I move amendment No. 47:
In page 10, line 31, after "comply with a" to insert "written".
It is important that requirements by the health board be made in writing to avoid possible future disputes. We have all had people come into our clinics to say that they were told certain things by a certain official but when asked if they had anything in writing to back it up they had not, and verbal utterances have no meaning whatsoever. It is important again to have clarity. I do not think it would be a major imposition if the Minister were to accept this in the same way as he accepted private interviews in a sensible way. I would ask him to accept amendment No. 47.
I would also hope the Minister would take this simple amendment on board. It seems eminently sensible.
I do not propose to accept the amendment because it could cause difficulties in enforcing the nursing home legislation. For example, the amendment could be construed as meaning that a health board would have to give a nursing home notice of an inspection or that a health board would have to put in writing a request to see staff records, which must be maintained under the regulations. Such a situation would undermine the value of inspections and I consider it reasonable that any requirements of the health board following an inspection should be made in writing. Again the issue can be dealt with in the code of practice. I believe it is important, and I am sure the Members of the House would consider it important, that the inspectors should have the right to visit a nursing home without giving notice in writing of their intention to do so. I believe that is in the interests of the dependent persons who are in the nursing homes.
In view of what the Minister has said and because I wish to get on to section 7, on which I certainly intend to press an amendment, I will withdraw this.
Amendment, by leave, withdrawn.
I move amendment No. 48:
In page 10, line 41, before ", the health board" to insert "which shall be completed within 30 days of receipt of an application".
Because amendments Nos. 49 and 51 are out of order, I would like to give notice that on this amendment I will cover the matters at issue. I would like the Minister, in his one contribution, to make a clear statement to the House. We are irreconcilable in our view of the shabby way this amendment, No. 48, has been delayed. I instanced a case last week where there was a six month delay and talked about my total dissatisfaction with the subvention. This whole question of subventions needs to be radically improved. The present situation is arbitrary and confusing. The Minister is being less than frank here in saying what his intentions are in regard to the subvention.
I would like the Minister to say specifically how many different grades of subvention he intends to introduce after the passing of this legislation and what he envisages those levels of payment will be. Will there be two, three or four? Will there be one or two? What will be the rate of payment? I would ask the Minister to be quite explicit because people are depending on these. The relatives of these people cannot afford to pay the cost of these nursing homes.
The cost of staying in a nursing home after the passage of this legislation is likely to increase because of the increased standards that will be put in place. There is an unacceptable delay in the processing of subventions. People who were certain they were going to receive them find that they did not. Therefore I will be pressing this amendment No. 48 to a vote.
I ask the Minister to seriously review the policy in relation to subventions. Deputies Howlin and Sherlock and I have outlined the situation time and time again. There have been closures of geriatric and long-stay beds and this means people are depending on nursing homes whether they like it or not. The geriatric assessment committees are putting people into nursing homes. There has been no new approved home since 1980. This Bill will resolve that problem. We have moved from "shall" to "may" and I do not accept that means that everyone will get a subvention. Previously that has not been the case. I would ask the Minister to at least clarify his understanding of the subvention in terms of the number of grades and the rates of payment.
It may be an inappropriate vehicle but because of the way we work in this House we have to discuss an amendment to deal with what we want to get at, which is section 7, the core of the Bill. We had a long discussion on it on Committee Stage and, unfortunately, the amendments I put down were out of order. I did not bother resubmitting them, therefore, because they would be out of order now as they would put a charge on the State.
The logic of the argument I made at that stage remains as valid tonight as it was last week, when my amendments Nos. 50 and 51 were adjudged to be out of order. There are two things happening. There is a mushrooming of private nursing home care, which is not a bad thing in itself. Unfortunately, the cause of it is a bad thing. The cause is the systematic withdrawal of State care, the closure of geriatric beds. It is a positive thing to enact this Bill because it provides a framework of shelter and protection for people in private nursing homes. What I am dreadfully afraid of, however, is that there would be a category of people who will simply have no provision for their old age. They will not be able to find a geriatric bed in what used to be the old county home because the pressure on those is too severe, and they will not be able to afford a private nursing home. The Minister knows as well as I do the anguish of individual families and elderly people who literally have nowhere to go and they struggle along in impossible situations in overcrowded families doing tremendous psychological damage to two or three generations of the family at the same time because there is no other option.
If there were to be 1,001 new private nursing homes established, all of five star quality, if a whole category of people simply cannot afford to get into them, we have done nothing. This is the flaw in this Bill that I referred to earlier. This is a flaw because there is a category of people who will be excluded from the provisions of this Bill. They will not be covered by State provision and they will not be able to afford private nursing homes. It is imperative that the Minister provide for those not, as he has done in this section, in a half-hearted way where the health board, who are already squeezed for money, have the option of giving a proportion of support to people who are residents in nursing homes. It is simply not good enough. It is the crucial failing in this legislation. We will enact it and it will be great for those people who are in nursing homes but it will do nothing for that whole category of people who are excluded. I could speak for a long time on this but I will constrain myself to underscoring this as the most serious flaw in this otherwise excellent legislation. Will the Minister promise to look again, when preparing the regulations and funding for health boards, at the need to make proper provision for people in that category?
I agree wholeheartedly with what Deputy Howlin said. The question of the fee and the subvention are inter-related. I dealt with the question of subvention and I do not propose to say anything more about it but if the Minister is serious about introducing proper legislation governing nursing homes and accommodation there for elderly people, it is inevitable that a regulated subvention should be payable by health boards.
It is a matter of disappointment to me that, having been through Second Stage and Committee Stage, Deputy Howlin believes that the increase in the number of nursing homes is due to the withdrawal of geriatric beds.
There is some truth in that.
I was surprised to hear that because if one looks at Dublin, where the largest proportion of the population lives, one will see that there has been an increase in the number of nursing homes because of the very good care our people get and the very good health services we have. Thank God that, because of that, people are living longer. The proportion of elderly people in our community is increasing. People are living longer and we should recognise that that is the reason we need more places on top of those that are provided by the health boards. The Government recognise that and allocated an extra £5 million in the budget to provide extra services for the increased number of elderly in our population.
I do not propose to accept the amendment because health boards will be expected to deal with applications for a subvention very promptly. I am prepared to include in the code of practice a reasonable time within which boards should carry out assessments, but I am not prepared to put such a time limit in the Bill. There may be very good reasons that an assessment cannot be carried out within one month of the receipt of applications. For example, the family doctor may be on holidays or the patient may have died after the receipt of the application for assessment. In such instances, if we accepted the amendment, the health board would be required to complete the assessment within 30 days. We are very anxious to ensure that the investigation of any application is expedited but the correct place to have this enshrined is in the code of practice and not in the Bill.
Deputy Yates asked me about the subvention and I should like to tell him that it will be targeted at those who need it. In my view, contrary to what Deputy Howlin has said, there is an enlightened approach to applications. There will be at least three categories, and possibly a fourth. There will be the mildly disabled, the moderately disabled and those in need of care and attention and, perhaps, an extra category for those with Alzheimers disease. The thrust of the legislation is to ensure that the resources available are targeted at those in need on the basis of means and, secondly and very importantly, on the degree of care they need. The subvention will increase according to the degree of care a person needs.
What level does the Minister have in mind?
I cannot say that at this stage. We can talk about that later.
The last remark by the Minister reveals his hand.
If we get this Bill through we will have £500,000 for this year.
This is the crunch issue because quality care nursing homes are out of the reach of many people. A person's pension is about £50 per week and we are talking about nursing homes that cost £120 plus per week. If we are serious about making this good quality of care available to people, adequate resources must be made available by the Government. Health boards must be obliged to provide assistance. The Minister has had an opportunity to make the discretionary aspect of funding from health boards obligatory but he has not done so. The State is failing in its obligations and I must press my amendment.
Amendment put.
The Dáil divided: Tá, 63; Níl, 71.
Tá
- Ahearn, Therese.
- Allen, Bernard.
- Bell, Michael.
- Belton, Louis J.
- Boylan, Andrew.
- Bradford, Paul.
- Browne, John (Carlow-Kilkenny).
- Bruton, John.
- Bruton, Richard.
- Byrne, Eric.
- Carey, Donal.
- Connaughton, Paul.
- Connor, John.
- Cotter, Bill.
- Creed, Michael.
- Currie, Austin.
- D'Arcy, Michael.
- Deasy, Austin.
- Doyle, Joe.
- Dukes, Alan.
- Durkan, Bernard.
- Farrelly, John V.
- Ferris, Michael.
- Finucane, Michael.
- FitzGerald, Garret.
- Flaherty, Mary.
- Flanagan, Charles.
- Garland, Roger.
- Gilmore, Eamon.
- Gregory, Tony.
- Higgins, Jim.
- Higgins, Michael D.
- Hogan, Philip.
- Howlin, Brendan.
- Kavanagh, Liam.
- Kemmy, Jim.
- Kenny, Enda.
- Lowry, Michael.
- McCartan, Pat.
- McCormark, Pádraic.
- Mac Giolla, Tomás.
- McGrath, Paul.
- Moynihan, Michael.
- Nealon, Ted.
- O'Brien, Fergus.
- O'Keeffe, Jim.
- O'Shea, Brian.
- O'Sullivan, Gerry.
- O'Sullivan, Toddy.
- Owen, Nora.
- Pattison, Séamus.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reynolds, Gerry.
- Ryan, Seán.
- Sheehan, Patrick J.
- Sherlock, Joe.
- Spring, Dick.
- Stagg, Emmet.
- Taylor, Mervyn.
- Taylor-Quinn, Madeleine.
- Timmins, Godfrey.
- Yates, Ivan.
Níl
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brennan, Mattie.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John (Wexford).
- Calleary, Seán.
- Callely, Ivor.
- Clohessy, Peadar.
- Connolly, Ger.
- Flynn, Pádraig.
- Gallagher, Pat the Cope.
- Harney, Mary.
- Hillery, Brian.
- Hilliard, Colm.
- Hyland, Liam.
- Jacob, Joe.
- Kelly, Laurence.
- Kenneally, Brendan.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Leonard, Jimmy.
- Lyons, Denis.
- Martin, Micheál.
- McCreevy, Charlie.
- McDaid, Jim.
- McEllistrim, Tom.
- Molloy, Robert.
- Morley, P. J.
- Nolan, M.J.
- Coughlan Mary Theresa.
- Cowen, Brian.
- Cullimore, Séamus.
- Daly, Brendan.
- Davern, Noel.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Ellis, John.
- Fahey, Frank.
- Fahey, Jackie.
- Fitzgerald, Liam Joseph.
- Fitzpatrick, Dermot.
- Flood, Chris.
- Noonan, Michael J.
- (Limerick West).
- O'Connell, John.
- O'Dea, Willie.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Ned.
- O'Leary, John.
- O'Rourke, Mary.
- O'Toole, Martin Joe.
- Power, Seán.
- Quill, Máirín.
- Reynolds, Albert.
- Roche, Dick.
- Smith, Michael.
- Stafford, John.
- Tunney, Jim.
- Wallace, Dan.
- Wallace, Mary.
- Walsh, Joe.
- Wilson, John P.
- Wyse, Pearse.
Tellers: Tá, Deputies J. Higgins and Boylan; Níl, Deputies Gallagher and Clohessy.
Amendment declared lost.
We now move to amendment No. 48a, in the name of an tAire, which has already been discussed.
I move amendment No. 48a:
In page 10, between lines 48 and 49, to insert the following:
"(b) in paragraph (a) nursing home' includes an institution referred to in section 2 (1) (h).".
Amendment agreed to.
Amendment No. 49 not moved.
I move amendment No. 50:
In page 10, after line 53, to insert the following:
"(3) Where it is proposed to make regulations under this section, a draft of each such regulation shall be laid before each of the Houses of the Oireachtas, and the regulation shall not come into effect until a motion approving of the draft has been passed by each such House.".
I wish to make a brief comment on this amendment. Section 7 (2) provides that the Minister may by regulations prescribe the amounts that may be paid by health boards and such amounts may be specified by reference to specified degrees of dependency, specified means or circumstances of dependent persons or such other matters as the Minister considers appropriate.
Because of the whole range of amounts covered by the provisions of that subsection it is essential that the Minister should bring any regulations he proposes to make before each House of the Oireachtas. I would ask the Minister to accept the amendment. Having debated a Bill with very wide-ranging conditions, which will require draft regulations, at least each House of the Oireachtas should be afforded an opportunity to discuss them.
I did consider this amendment tabled by Deputy Sherlock. The Bill, as drafted, is in accordance with the manner in which this type of legislation comes before the House. I am satisfied that the provision in the Bill is satisfactory and will do the job both Deputy Sherlock and I desire.
Amendment, by leave, withdrawn.
Amendments Nos. 51 and 51a not moved.
Amendment No. 52, by leave, withdrawn.
I move amendment No. 52a:
In page 11, line 13, to delete "is of opinion" and substitute "has reasonable cause to believe".
I believe that the use of the phrase "is of opinion" is too vague. In order that this clause be effectively operated it would be better if it read: "has reasonable cause to believe". Perhaps the Minister would consider accepting that amendment.
This issue was dealt with extensively on Committee Stage. The legal opinion available to me is that the phrase "is of opinion" carries much more legal weight than "has reasonable cause to believe". Because of that legal advice I do not intend to accept the amendment.
Amendment, by leave, withdrawn.
I move amendment No. 53:
In page 11, line 33, to delete "subsection (1)" and substitute "paragraph (a)".
Amendment agreed to.
Amendments Nos. 54 and 55, by leave, withdrawn.
Amendment No. 56 not moved.
Amendment No. 57, in the name of the Minister. Amendment No. 58 is an alternative amendment. With the agreement of the House, perhaps both can be discussed together. Agreed.
I move amendment No. 57:
In page 12, to delete lines 49 to 51 and substitute the following:
"(3) A dependent person shall not be cared for or maintained for profit in a dwelling in what a person is boarded out under this section.".
Amendment agreed to.
Amendments Nos. 58 and 59, by leave, withdrawn.
I move amendment No. 60:
In page 13, between lines 38 and 39, to insert the following:
"14.—The person carrying on a nursing home shall supply the health board on request with either a certificate from the statutory fire authority or written confirmation that all such requirements of the fire authority have been adhered to by a suitably qualified bonded architect or engineer."
While I will not be pressing it, perhaps the Minister would respond to this amendment. If he has any objection to it, I should say my objective is to have a fire certificate furnished to the relevant health board affording that protection to all nursing homes, so that there would be no risk of fire danger to their patients or residents in that regard.
I share Deputy Yates's concern. The Department of the Environment and ourselves have discussed such fire certificates. They will be incorporated in the regulations. I should say that the Irish Nursing Homes' Association have accepted the provision.
Amendment, by leave, withdrawn.
Amendment No. 61, by leave, withdrawn.
Question: "That the Bill, as amended, be received for final consideration". Put and agreed to.
Agreed to take Fifth Stage today.
Question proposed: "That the Bill do now pass."
I should like first, to thank my colleagues in the House for their co-operation throughout Second, Committee and Report Stages, when we had a very worthwhile debate. The amendments I tabled and also those tabled as a result of recommendations and suggestions on the part of Deputies Yates, Howlin, Sherlock and Garland have improved this Bill. I also wish to thank the officials in my Department, the parliamentary draftsman and all those involved in preparing what is a very good Bill. I should also like to thank the officials of this House, particularly in regard to Committee Stage, when procedure was rather complex when we had to deal with a number of amendments together. Finally, I should like to thank the Ceann Comhairle, yourself, a Leas-Cheann Comhairle, and the various Acting Chairmen who bore with us in the course of our discussions.
We agree to the Fifth Stage. I should like to thank the Minister for his open attitude, particularly on Report Stage, and for accepting a number of our amendments. It would have been possible for us to spend a good deal longer on both Committee and Report Stages. In return for the co-operation of the Opposition, perhaps the Minister would consider exerting pressure on his Chief Whip to allow the amending legislation to the Clinical Trials Act to be taken this session as a quid pro quo. I should like to be associated with the Minister's kind remarks with regard to all those associated with this Bill.
I commend the Bill. It is a very important one, which was why there was such a co-operative spirit on all sides of the House in order that it be enacted as quickly as possible. It affords fundamental and important safeguards to people resident in private nursing homes.
I should also like to thank the Minister for the very open and co-operative manner in which he approached this whole debate. He was amenable to positive, constructive contributions from this side of the House. It is not every Minister of any political party who will do that. I commend him strongly for having taken seriously our recommendations and suggestions. I should also like to be associated with his commendation of his officials who worked long and hard on this and those officials of the House who worked so competently and expeditiously with a very difficult series of amendments on Committee Stage, in particular, when we had a wide-ranging debate. I am delighted that this Bill will soon be enacted.
I wish to concur with the Minister and my colleagues in commending everybody who has been associated with the Bill. It was indeed interesting to be involved in the passage of a Bill which is so important at this time. While the Minister did not accept all amendments tabled, I accept his sincerity and have no doubt that he will devote adequate attention to all of the suggestions we made.
Question put and agreed to.