Health Services: Motion.

I move:

That Dáil Éireann,

conscious of issues which compromise patient safety such as those exposed in:

the Lourdes Hospital Inquiry Report;

the report on the death of Mr. Pat Joe Walsh;

the case of Mr. Peter McKenna; and

the Leas Cross reports;

aware that the creation of one single employer, the HSE, for a majority of the staff who work in the health services, supports the case for the establishment of an independent body with a strong legislative base which is focused on patient safety;

calls on the Government to:

immediately establish a patient safety authority to put patient safety at the heart of the health services and to inter alia:

set and monitor standards of patient safety in all registered health and social care facilities;

advise on patient safety, investigate complaints and carry out quality reviews;

act as the commissioner for mental health services; and

facilitate "whistleblowers".

I wish to share time with Deputies McManus and Crawford.

Is that agreed? Agreed.

There is no doubt this is a very important Private Members' motion, where we will speak about a patient safety authority for our health service. I feel strongly about this issue and I am absolutely shocked at the way Ministers have responded. A reign of terror against elderly patients was benignly described as a systems failure by the HSE. On Friday, the Minister, Deputy Harney, poured out what can only be described as useless regret when she stated: "We are learning lessons from this, and we are implementing significant changes to give the required assurance to older people about care standards."

The Minister went on to condemn the complete lack of respect for older people and their dignity which prevailed in the nursing home at Leas Cross. We are not becoming immune to this type of hypocrisy. Neither the Minister nor any Minister could muster up enough interest, let alone respect, to attend the press briefing on the publication of the Leas Cross report. That was in itself one of the most shocking facets of the publication of the report. None of the Ministers even bothered to turn up to give some condolence to the families involved or to indicate that the families were respected and their anger and sadness was understood. Those who did not turn up included the Minister, the Taoiseach, the former Minister for Health and Children, Deputy Martin, the Minister of State, Deputy Seán Power, and the former Minister of State, Deputy Callely. None was available to any of the family members at the publication of this report. That was absolutely shocking.

If this report has been referred to the Garda Síochána for whatever reason, why is it the Opposition's Private Members' time which is being used to discuss the report? Why is no urgent debate being organised by the Government on this report? It has been referred to the Garda Síochána, but no need is felt to discuss this significant report in the House, and that is absolutely unbelievable. I will make the charge that there is a cover-up involved with much of this.

Which Ministers knew about what was going on in Leas Cross and what of the other establishments like Leas Cross that have yet to be exposed? Did senior management collude with Ministers with regard to what was known about the occurrences in Leas Cross and other institutions? Did Ministers insist that senior management stay quiet about what was happening in these institutions? This is an unbelievable report that is receiving almost a Mickey Mouse response from the Government. The arrogance is unbelievable.

There is no doubt the Government failed to respond to warnings about what was happening to elderly patients in a small number of institutions. If Ministers were not informed, there was serious negligence on behalf of HSE officials. The self-serving explanations at the back of the Leas Cross report will not get these officials off the hook. We know inspectors of nursing homes, doctors, nurses and other administrators told senior management what was going on, but nothing was done. Somebody must take responsibility for the issue.

There is now an opportunity for officials to come out and state what occurred. It is an opportunity for every official in the HSE to state what happened. There is no way Ministers will get away with what occurred here. I am asking people who work in the HSE to step forward. As a political party, Fianna Fáil has lost all credibility as the defenders of the poor and vulnerable. It shows here tonight, when not even one member of the Fianna Fáil parliamentary party could even bother to turn up for this debate.

What does it take to stir Fianna Fáil into real action today, when somebody like Peter McKenna died from neglect in a nursing home or when somebody like P. J. Walsh was allowed to bleed to death in one of our acute hospitals? It is unbelievable to think that a political party which claims to represent the poor is sitting in government doing absolutely nothing while this happens.

The "Prime Time" exposure of the scandal at Leas Cross was the first real public view of what people such as Deputy O'Dowd have been stating in this House for a long time and what we now know individuals such as Martin Hynes were stating in reports which were sent to the HSE. Even today nothing has been done to protect patients to any substantial degree. That is what is shocking about this matter.

Although we all know the Government knew what was going on beforehand and although this Government really only responds to what happens in the media, there was no response when this case was exposed on "Prime Time" for the entire public to see what we all knew was going on for some time. There was absolutely no response of any great significance.

Fianna Fáil deserves a significant amount of the abuse it should get on this issue. It has allowed poor souls to be tortured in what is basically Ireland's version of Abu Ghraib, the notorious prison in Baghdad. Nothing has been done about it. That the Taoiseach has not sacked either the former Minister for Health and Children, Deputy Martin, or the former Minister of State, Deputy Callely, on the basis of what is coming out here, or that he has not demanded a full inquiry by the Oireachtas Joint Committee on Health and Children is absolutely shocking.

It is probably arrogance, incompetence or pure laziness and the trappings of power that are preventing the Government from doing anything. It is so far removed, it does not care. The Government believes this in a thriving economy. These patients died as the Government cares about nothing else but the cost of treating people. It has no idea of what it is to value people anymore. That will be its Achilles heel when it comes to facing the people in a few months' time.

Fine Gael today announced it would set up a patient safety authority. The basis of this authority is long overdue. One of the core points of a patient safety authority is that it would be independent and it would not only set standards and accredit institutions, but there would be a system within it where people could make a complaint. The patient safety authority would be obliged to write reports which go to the Minister. I have noticed that with the establishment of the HSE, the Minister is around for all the nice things, but once the heat comes on, the HSE is responsible.

Are there any nice things? I have not heard the Deputy mention any.

The Minister has been out a few times. There must be a few nice things going on in the HSE, according to her.

The Deputy should tell me what they are.

The Minister lets the HSE handle all the other issues. There is a sense that if politicians and the Government, delegated by the people to look after the health services, do not care, why should senior management and people further down the system? That is currently creeping into the health system.

Hear, hear.

We want to stop that. We wish to see control going back into the political institutions to protect patients. What good is it for the Taoiseach to talk about a referendum to protect children's rights under the Constitution when the same Government cannot protect the rights of elderly patients, which are already enshrined in the Constitution? The reason these cannot be protected is either that the Government is not enforcing the law in the way it should or it does not care.

All the legislation that should be introduced to protect patients is not being produced. The Minister will know from when she was Tánaiste that under the programme for Government the social services inspectorate was a priority in 2002, after it had found its way into the health strategy Quality and Fairness — A Health System for You in 2001. Yet here we are, five or six years down the road with little progress.

I have heard references to the term "successive Governments" with regard to illegal nursing home charges. We knew this would be a priority issue from 2001, yet nothing was done. The Government spoke about it every year. It referred to it in 2002 when it made up its programme for Government and it was mentioned again in 2003 when the first reports emerged of what might be happening in Leas Cross and similar institutions as it became a Government priority.

We can almost be guaranteed that events will continue as they have with HIQA, the Minister's idea for protecting patients. I do not agree with this and I do not believe it will protect patients the way the Minister claims it will. The social services inspectorate section of HIQA, if given the proper legislation, could protect patients, yet that will not see the light of day with the Government. That is a most damning indictment. It is important the patient safety authority which Fine Gael is talking about is established.

The appendices to the Leas Cross report show how senior management in the HSE tried to justify their actions: "At no stage during my tenure was the quality of care relating to patients in Leas Cross mentioned or reported to me personally". These are the words of a former chief executive officer of the health board. It was stated that nobody informed him or her that there was a problem in Leas Cross. This is the first question for the detective sergeant who goes in to interview that CEO when looking for the paper trail. Another former deputy chief executive officer stated the Northern Area Health Board management were satisfied that they had put a robust system in place that could adequately deal with issues arising in the course of inspections.

Both the official report and the appendices show that a large number of inspectors were clearly concerned that the information they were writing in their reports was not finding its way up the line. There were individuals further up the line who may or may not have been passing on this information.

Will the Minister provide the Garda Síochána with the details of all the individuals who were part of the nursing home inspectorate of this health board area in the past four years? Where are all the senior individuals in the nursing home inspection unit of the Northern Area Health Board now? People retire and people move on but have there been attempts by the HSE to scatter these people across the system or persuade them to take early retirement to avoid embarrassment for the Minister in the course of the next couple of months? The Minister needs to pre-empt a Garda investigation and bring this debate back into this House.

She has failed badly in her protection of patients. She has not dealt with a whole list of issues. Will the Minister continue with the 5% ruling which means taking an elderly person's house when they require private nursing home care? Why is she failing to publish a policy on funding care of the elderly? This Government has abandoned all its priorities with regard to the protection of patients. The Minister should begin an inquiry into the care of elderly patients because she is failing them in every single aspect. She is failing to provide a policy to fund their future care, even though she will be on the radio to tell us all how more nursing home care will be required for the increasing elderly population. The only care option currently being provided is private nursing home beds and this is the sector where the failings are most serious. It was damning of the Minister's tenure when the private nursing homes organisation took it upon itself to implement a set of standards for private nursing homes because it knew the Minister's inaction was dragging them down. She has refused to deal with the minority of nursing homes that are failing patients in a most dramatic way. It is time for the Minister to take stock and to protect patients. She must stop thinking the only action the Government needs to take is to throw a few trinkets at everybody at budget time and to announce grand schemes. She is supposed to be protecting patients but she is not doing so.

Last Friday, the day after the Leas Cross report was published and a few hours after Fine Gael submitted its Private Members' motion, the HSE issued a press release stating that what was needed was a patient safety agency. There is no great belief that either the HSE or the Minister will protect patients; the HSE is simply responding to what is stated in the media and this needs to stop immediately.

The Minister must put her legislation to protect patients in order. She should follow Fine Gael's lead, change the way she is trying to set up HIQA and its remit and focus more on a patient safety authority which would concentrate on the needs of patients. It seems HIQA is all about processes and saving money. Much of the work of HIQA is to do with costing drugs, diagnostics and treatments to decide whether or not they will be given to patients. The manner in which elderly people in nursing homes are being treated does not bode well for the rest of the patient population if the Minister continues with this line of thinking. She needs to take some advice from the Opposition and set up a patient safety authority before she goes any further.

With reference to what has happened in Leas Cross and to the Peter McKenna and PJ Walsh inquiries, the Minister should institute a Dáil inquiry and bring governance of this country back into Dáil Éireann. There should be a proper discussion in this House about how this misery and terror happened to elderly people in one nursing home and is happening and has happened in the past in other nursing homes. The Minister needs to move quickly on this issue but I do not think she is doing so. Those of us on this side of the House are extremely disappointed because this issue has been raised consistently. In July 2005 during the course of a "Prime Time" programme, the whole country witnessed shocking abuse of a proportion of elderly people. They questioned whether this could really happen in Ireland's health care service.

Does the Minister now regret that somebody of the integrity of Professor Des O'Neill was asked to write the report? A person of his integrity would never write a report to merely satisfy his political masters. He would write a report that would have an influence on patient care and this is what was delivered. What were the legal impediments to the Leas Cross report that prevented the Minister from publishing it for so many months? Why did she keep it on her desk and tell us there were legal problems but as soon as they were exposed, the report was published within three weeks? This is important from the point of view of her governance. She should not collude with some of her senior managers to cover up what is happening within the health services and dress it all up with media-friendly advice that everything is hunky dory and rosy in the health care service when we know that serious problems exist. That cover up is a national disgrace and a national scandal. It is time for the Minister to be more proactive in protecting patients and to tell us what is happening in the health care service. I hope the Minister will take some of our concerns on board.

I welcome this opportunity to debate this important issue of patient safety. I thank Fine Gael for sharing their time in this important debate. This issue has never been more important than it is now. In recent times there has been a litany of shocking revelations about deficiencies in the health service to such an extent that public confidence has been undermined.

The task of any Government is to restore confidence in the health service and to introduce robust, effective measures that are statutorily based and serve to empower and protect patients. Instead the Government has prevaricated, obfuscated and delayed taking the necessary action. When the Leas Cross nursing home scandal was broken by RTE, the Taoiseach promised swift action and new legislation, yet 18 months on, we are still waiting. When tough decisions were to be made, the Minister, Deputy Harney, talked tough, but when the time came last May to publish the Leas Cross nursing home report, she hid behind her legal advice. We pointed out very clearly that the Minister had the authority under the Health Act 2004 to ensure the publication of this report. She chose not to do so. A press conference was held last week to oversee the report's publication. Remarkably, not a single Minister turned up. That was probably the most telling point. The abject absence of political leadership simply added to the distress and pain experienced by the families of those who died at Leas Cross. People found it unfathomable that there should have been such an absence of political leadership.

This report can now be added to the sad litany of reports that has built up during the Government's watch. The Our Lady of Lourdes Hospital Inquiry report, the report on the deaths of Pat Joe Walsh, Peter McKenna and Róisín Ruddle, and the Leas Cross report are only some of the reports that examine institutional abuse of the elderly, the surgical mutilation of young women and the death of a middle-aged man who bled to death in a modern Irish hospital. Other tragic events have also been examined.

There is also the anecdotal evidence that arrives on Members' desks on a regular basis. The patient who contracted MRSA but was not told about it and the family only discovered the fact when it appeared on the death certificate. The child with a broken arm left for 20 hours without water in a hospital ward. An older man left undiagnosed in extreme discomfort and covered in his own faeces while in hospital. The complaints range from dirt in the toilets to the death of a child through medical misadventure. These complaints are disturbing, but when we get them we ask ourselves what we can do with them. There is nobody we can trust to ensure these complaints are acted upon. The complaints we get are only a drop in the ocean. Data collected by the State Claims Agency show that 1,000 adverse incidents involving patient care are occurring in Irish hospitals every week. It is estimated that this is only 30% or 40% of the real figure.

Action needs to be taken, but it cannot be small-minded, defensive, or of the typically minimalist approach that the Government appears to think is good enough. We need an independent, co-ordinated and standardised approach to patient safety with clear accountability, including political accountability, and enforcement. It is interesting to note that among service providers, including private nursing homes, there is an appetite for better co-operation and improvement in inspections and regulation to allow staff deliver services. People want to deliver facilities and treatment, but they want to do so in circumstances where everybody is governed by best practice.

Labour and Fine Gael recognise the urgent need for the establishment of an independent body with a strong legislative base, focused on patient safety. We have joined forces and today published the framework for a patient safety authority that puts patient safety at the heart of the health service. We want a robust, statutory authority to empower and protect patients. We want to restore confidence in a health service system that has become dogged by too many scandals, too much neglect and too many people dying needlessly and without dignity. The irony is that we have great health professionals who work hard to ameliorate the effects of illness and ill health. They often work in very trying conditions that are overcrowded and overstretched. Both patients and health professionals deserve better from a Government that has let them down so badly.

Labour and Fine Gael propose a patient safety authority that will bring ministerial responsibility back into the health service. It is essential that patients within our health service feel safe and know they have an authority that advocates for them and demands answers on their behalf, as well as having the power to improve standards of care and safeguard patient safety.

The report of Our Lady of Lourdes Hospital Inquiry is one of the most revealing accounts of medical failure in the history of the State. It raises serious questions about how the State ensures patients are properly protected from doctors who may lose the ability to perform to an acceptable standard. It beggars belief that so many women could have been subjected to what amounts to unnecessary surgical mutilation of their bodies. The distress caused to those women, often young women, by the removal of their wombs without their consent, thus robbing them of the capacity to have further children, is almost unimaginable. Anyone reading this report will wonder how it happened and how it went on for so long. Yet, were it not for the courage of a midwife and the swift response of the health board, the medical practice and the consultant would still be in operation today. From 1974 to 1998, 129 women were subjected to this practice until someone blew the whistle. To this day, that whistleblower has not been identified publicly. That is telling too. The shocking fact is that were it not for the courage of a relatively junior midwife who drew attention to Dr. Neary's record in 1998, more women could have suffered.

This case clearly highlights the urgent need to provide legislative protection for whistleblowers, not just within the health sector but in all areas of Irish life. The Labour Party has long sought protection for whistleblowers who are worried about bad practices or wrongdoing in their place of work. The patient safety authority will give protection to whistleblowers who act in good faith where there is danger to health and safety of a patient, staff member or member of the public, miscarriages of justice or crimes or breaches of legal obligations. The leader of the Labour Party introduced the Whistleblowers Protection Bill in 1999. It passed Second Stage in June of that year, but the Government has since resisted all efforts to have it progressed further. The culture of secrecy continues. I noted a doctor complaining most vehemently about the most recent draft consultants' contract which contains a clause that would deny consultants the right to talk to the media or the public of serious concerns they may have. While that stricture may have applied in the past, it goes completely against the rhetoric so often used by the Minister for Health and Children who promises accountability. At the same time as she is espousing this rhetoric, she is responsible for shutting down the best and long-standing conduits of information when setting up the Health Service Executive.

I note that the HSE yesterday launched an initiative called "Use the Right Door". While I am sure it is a good initiative, I am equally sure it would raise a wry smile among many people. The real difficulty with the HSE is that one cannot find the right door. If one is seeking information or trying to find the person responsible, one does not know which door to use — there probably is no door anyway. One is fobbed off by the Minister for Health and Children when one puts down a parliamentary question. The HSE may respond six months later saying that it does not have the information, but may have it in a further six months. This is the reality of trying to access information from the health service.

There is one lesson more than any other that we should have learned from all the scandals that have been revealed and the anecdotal evidence we receive in correspondence — terrible things can happen where there is a culture of secrecy and where a service as important as the health service is neither open nor accountable. It is dangerous for patients to be treated within a closed system. It is much better to have openness and accountability so people feel they can trust the service. A patient safety authority can provide that security. We do not currently have this. Public representatives do not know where to turn.

It makes no sense to write to the HSE. It is a vicious circle. One is complaining to the people responsible for the problem. When the HSE was to be established, before Deputy Harney took over as Minister, there was a clear framework to set up a parallel system comprising the HSE and an authority that would ensure information and quality standards. However, the Government does not see the importance of quality, information and standards. It never got the balance right. There would have been tensions with the parallel system because a statutory authority would have been established at the same time as the HSE as a watchdog or guardian for patients, the type of authority we have elaborated on in a more comprehensive form in our proposal for a patient safety authority.

We got nothing and since then we have seen what can happen. We see it in the Leas Cross report: institutionalised abuse of elderly and frail people. That is the legacy and to this day, despite all we have read and seen on television, we know it is not restricted to Leas Cross. We also know the Government does not have its act together and the legislation does not exist. There is no excuse for prevarication. While the Government has no problem speeding legislation into the House to ensure people pay nursing home charges, it cannot provide for the protection of patients. It is the characteristic of the Government. It can provide tax breaks for private hospitals but cannot deliver the 200,000 medical cards it promised. That is a feature of a Government that is incapable of ensuring that patients are the centre of our health service. We must empower patients. If we fail to do so we must live with this litany of deficiencies, failure and neglect which we have seen in these reports. That is one of the great failings of the Minister and her predecessor, who established the idea of getting rid of the health boards willy nilly and establishing a central body. It is hard for any of us to pinpoint the benefits of the HSE. Perhaps the Minister will tell us what, precisely, has been the experience of patients that allows them to say it was a good political move to deliver a central body.

I know a public patient who has waited 15 weeks for open heart surgery and has been told he will have to wait three to five weeks longer. He is an ordinary, working-class man who deserves better. What can I do for him? Where can I go to say what is happening to him is wrong? I hope this will bring a change of heart from the Government, but I suspect it will not. There will be more defensiveness. We have seen from the amendment to this motion that we are getting more of the same. That is a pity and I regret it. Irish patients deserve better.

I thank Deputies Twomey and McManus for bringing this issue into the Dáil. We receive many lectures about patient safety being the No. 1 issue. As somebody from County Monaghan, I agree that patient safety is, and should be, the No. 1 priority. However, when one considers Leas Cross and the case of Mr. Pat Joe Walsh, one wonders where is the systematic failure. As Deputy McManus spoke about some of the cases, I could not help thinking back to a short time after I entered this House when, on routine work, I met a young girl in Kingscourt whose sister was in need of urgent surgery. She had been put through the ropes and received all sorts of promises, but nothing happened. I went to the then Minister for Health, Deputy Howlin, told him the story and within days the matter had been dealt with. That was at a time when there was no money in the State, when money and all sorts of items were scarce. The Government has said there is no need to collect any more stamp duty because there is too much money. However, the families of Mr. Walsh and many others have to grieve. I again sympathise with them.

Mr. Walsh's family was not aware that he was being moved from Our Lady of Lourdes Hospital. He was moved solely because there was pressure on that hospital and the bed was needed. He went to Monaghan General Hospital with a bleeding ulcer and we know the result. There were difficulties with the amount of information that went with him from Our Lady of Lourdes Hospital. Although I do not have time to examine the entire report, it makes interesting reading. It states:

The inquiry has revealed systematic evidence of serious process failure [the words in which it is expressed are wonderful] at almost all levels of activity apart from the nursing care. This process failure resulted in an inability to achieve transfer of the patient. For example the on-call consultant in Cavan hospital was working under a policy that effectively precluded him from undertaking major GI surgical procedures.

The inquiry also reported "continued failure on the part of management over a sustained period of time to address the factors resulting in the failure of Mr. Walsh's hospital transfer". It cited "lack of engagement between management and clinicians" or consultants, recommended "major reassessment of management structures" and said "prime responsibility for this development lies with hospital management at both local and regional level".

Who is in charge of the health service? In Cavan-Monaghan we know there has been management failure for years. This issue has been in crisis in the north east. Surgeons have had to go to the courts to solve their problems, yet management is allowed to stay there. Who is responsible and who will take control? Last Thursday evening we were told that all the interest is in safety and the only way to ensure safety is to close down issues and ensure proper care is available. This report, like many others, has made it clear that management is a problem. We are told money is not the problem. Yet in the review done by Mr. Robinson of the then health board, he stated that because of the increased numbers in the NEHB region, we were short €130 million three years ago and 1,500 personnel to bring us into parity with other areas. I ask the Minister to take responsibility. We do not want any more waffle or extraordinary experts. We want ordinary consultants and people who have a clear record of doing good work, saving lives and creating safe conditions. We want to see them given the opportunity to work — then people such as Mr. Pat Joe Walsh will not die.

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"—welcomes the Government's commitment to promoting patient safety and high-quality health services and in particular to the setting up of the independent health information and quality authority which will progress the safety and quality agenda in the health services through setting and monitoring of safety and quality standards;

supports the Government's commitment to introducing legislation which, inter alia, will establish the social services inspectorate on a statutory basis, including a robust system of inspection and a strengthened registration and deregistration;

notes the proposed statutory role for the first time of the Office of the Chief Inspector of Social Services in inspecting and maintaining registers of residential centres for people with disabilities, children in need of care and protection and older people in public and private sectors;

notes the Government's commitment to ensuring that high-quality care is made available to all patients in public, private and voluntary nursing homes, and, in that context, welcomes the preparation of new and stronger regulations to update for the first time the Nursing Homes (Care and Welfare) (Amendment) Regulations 1994 and standards for residential care settings for older people;

welcomes the HSE's provision of information to the general public on nursing homes and its policy decision to make nursing home inspection reports available on its website, and, in particular, welcomes the publication of the Leas Cross report;

acknowledges the work which has been initiated since the publication of the Lourdes Hospital inquiry, including action at local level to improve clinical accountability and performance in the hospital;

recognises that high patient volumes are needed for specialist services to achieve the best clinical outcomes;

acknowledges the need to ensure that medical and surgical procedures are carried out at appropriate levels within the hospital network for best patient outcomes;

supports the Government's commitment to reforms that will achieve improved safety and quality outcomes for patients;

acknowledges that the HSE has put in place management structures at both corporate and hospital level with responsibility for ensuring quality and minimising risk;

notes the Government's commitment to the development of a protected environment in which staff may disclose concerns about patients' safety;

notes that the Minister for Health and Children will introduce regulations in early 2007 which will set out a statutory framework for the introduction of a complaints process throughout the HSE;

supports the important role of the Irish Health Services Accreditation Board and its work in applying accreditation standards to ensure safety and continuous quality improvement; and

commends the Government on measures to ensure that the patient safety needs of people with mental illness are monitored and protected by the Mental Health Commission and the Inspector of Mental Health Services."

If anything sums up the need to remove political interference from the day to day running of the health service, it is the case that Deputy Crawford has just mentioned. He said he had a particularly difficult case so he went to the then Minister for Health, Deputy Howlin, and the matter was addressed. If anything has to end in this country, it is political interference in the manner of choosing one patient ahead of another. The reality is that when the parties opposite last left Government, some 27,000 people were on hospital waiting lists.

The Minister cannot just say that.

She is living in the past.

The idea that we should put one patient ahead of another simply because of a political word——

At least he was able to get action.

——is not acceptable. Take, for example, breast cancer. In 2003, about 76 surgeons performed operations for this condition in 35 hospitals around the country. Some 39 of the surgeons operated on less than five cases in a whole year. We know from international experience that such a low volume of surgery is dangerous, the survival rate is poor and the outcomes are bad. As we seek to change that, which is what patient safety is all about, we are being loudly condemned by the Opposition, from which we have had not a single voice of support. We know, too, that with 53 acute hospitals serving a population of 4.3 million, we cannot safely provide the range of acute services that is required in every single one of them. Therefore, we have to make decisions, governed only by what is in the interest of safe patient care and how much of it can be provided as conveniently and locally as possible. That is what is determining the health reform agenda.

I frequently hear calls in this House for the old health board regime or something similar to be put back in place. Most of the criticisms heard this evening occurred under the watch of the old health board system, including the experiences at Leas Cross. It is certain that if we do not have a single entity such as the HSE, responsible for the delivery of the health care system for a population of 4.3 million and accountable to the Oireachtas for the money it gets — unlike the former health boards which were accountable to the then Minister for Health for how they spent the money even while they were responsible for delivering the service — there will not be good management, appropriate delivery of services or responsibility.

The reality, if we really want to be governed by patient safety considerations, is that we have to make tough decisions. Those decisions are being made and I look forward to receiving support for them over the coming months, in the light of tonight's motion.

Is there an acceptable level of mortality for those decisions?

I was criticised for rushing the Health Bill through in 2004——

Will the Minister address the incidence of the 17 lives lost in Monaghan?

——Deputy Connolly will have his chance to speak — because I was anxious to ensure that the new organisation should be up and running as quickly as possible. I was criticised for that happening too quickly. Now I am being criticised because the HIQA Bill is not fast enough. In March this year, I decided to publish the heads of that Bill. I got 70 submissions in the three months it was open for public consultation. I did not get a single submission from the Opposition parties. Not a single Deputy came forward to tell me what should be in the Bill or whether he or she liked the proposals that had been published. Deputy McManus can laugh, if she likes, but——

The Minister is blaming the Opposition, but the buck stops with the Minister.

I am simply saying the Opposition had an opportunity to put forward its perspective——

We are here in the Chamber. That is what we are here for.

——and I just make the point that I got nothing. I was criticised for not having consultation on the Health Bill and I decided I would have consultation on this Bill, as I have had on the Medical Practitioners Bill and the Pharmacy Bill. It is good to have consultation and there must be a timeframe for it. Although many other organisations saw fit to have an input and were taking many of the suggestions on board, it was interesting that there was no input from the Opposition parties.

The Minister should stick to the basic issue.

I want to answer one other question. I have been asked why the Leas Cross report sat on my desk.

On a point of order, I apologise for not making a submission to the Minister, but unfortunately——

That is not a point of order.

——-she has been keeping us too busy watching other aspects of the health service to do so.

That is not a point or order.

We have made several submissions on basic services to the Minister and she is not listening to them.

Deputy Connolly will have his opportunity to speak. Deputies have already had their opportunities, time is limited and the Minister should be allowed to continue uninterrupted.

I was asked by Deputy Twomey why the Leas Cross report was not published sooner and what was the legal advice. The report was commissioned by the Health Service Executive. The HSE received strong legal advice that it could not publish the report unless those who could be identified through it by virtue of the jobs they held had the opportunity to have their perspectives taken on board. I sought the advice of the Attorney General to see whether I could use the privilege of the House to publish the report, or do so through an Oireachtas committee. Again, the very strong advice I got from the Attorney General, about three weeks ago, was to the effect that if Professor O'Neill was not happy to take on board the input of those referred to, somebody else could do it and the report could then be published. That is what happened. People can criticise it, but tribunals have been established by this House which hear evidence in public and people have an opportunity to take legal advice in considering the questions being put to them.

It is no secret that the Moriarty tribunal, as we know from the newspapers, circulated facts it was going to disclose about individuals last September. Notwithstanding that they are public tribunals, hearing evidence in public, they are required under natural justice, according to the Constitution, to give the individuals concerned the opportunity to see the conclusions being drawn about them and to have an input. That is the law under which we operate, and the Constitution.

The exact same reasons were proffered in the case of the Pat Joe Walsh report. It will be released on an opportune date as well.

The Deputy will allow the Minister to continue.

If any of us was the subject of criticism, in all fairness, we are entitled to respond and to have that response considered. That is the reason it has taken a long time to get to the position we reached last Friday. Finally, as regards last Friday, I am now being criticised because I did not turn up at the press conference. If turning up at press conferences is a sign of commitment, interest and concern, then we have come a long way down the road in politics. It was not my job to be at that press conference. It was called by the people who commissioned the report, namely, the Health Service Executive. I was available to the press and gave extensive interviews. Deputy Twomey should know that I do not run from things. I took on this job as Minister for Health and Children well aware of the challenges and the difficulties. I love the job, the challenge and trying to do the right thing, which is what I remain focused on.

Professor O'Neill's report is obviously extraordinarily critical of the level of care in Leas Cross nursing home. It is a chronicle of neglect, no less harrowing for its being short and succinct. I deeply regret the distress caused to the older people and their families who have been affected by the failures of care shown in that report. There was a gross lack of respect for older people and their dignity. I know all Members of the House will join with me in condemning in the strongest possible terms what happened at Leas Cross. The fact the nursing home in question is now closed in respect of the previous management is some small measure, but this is of little comfort to the relatives of those whose loved ones were failed so badly. It is clear warning signs and complaints were not given the attention they were due. This is a message that emerges from Professor O'Neill's report, from analysis by Mr. Martin Hynes and from a separate report for the HSE by Dr. Dermot Power, who dealt with a number of individual complaints. These events and reports challenge us to respond in a comprehensive way. It is the intention of the Government to do so in three areas.

The Government will bring forward new legislation to strengthen regulation and inspections to assure the public about quality and safety. The legislation will be published before Christmas. The Government will continue to increase funding for services for older people substantially, as it has done this year. It will also fundamentally reform the basis on which we provide financial support for people needing long-term residential care, so that care is affordable and care at home and in the community can be supported as much as possible. These actions will respond to the challenges presented by the failures evident at Leas Cross, and meet the wider challenges of securing the best possible care and support for people in long-term care.

The motion from the Opposition parties is well-intentioned. It is also clear that the actions suggested in the motion are largely contained in, and borrowed from, the draft heads of the Bill I published in March. I welcome recent statements by some members of the Opposition that they intend to facilitate the passage through the House of the substantive health Bill that the Government will publish this session. I look forward to that co-operation.

The Bill is substantial, the centrepiece of the Government's reform programme. The draft heads I published amounted to 122 pages. Over three months, 73 organisations and individuals submitted comments, valuable input that is informing our work on the Bill. The Opposition calls for immediate setting up of a new agency. The Health Information and Quality Authority, HIQA, is already in existence on an interim basis. Its board is carrying out preparatory work for its role on a statutory basis and it has recruited a top class chief executive, Dr. Tracey Cooper, former deputy chief medical officer in the UK. Opposition Members have recently been briefed on the role and work of HIQA.

I wish to focus on one aspect of the new health Bill. It will provide for the office of the chief inspector of social services in HIQA, with specific statutory responsibilities for the registration and inspection of all nursing home places, both public and private. The chief inspector will also inspect residential centres for children and people with disabilities. This is not merely a process improvement. It will mean a major change in the strength and independence of inspections and will substantially increase public confidence.

In respect of nursing homes, the new regime will be stronger and more robust to ensure that standards of care, not just standards of buildings, are met. The chief inspector will inspect the homes against new regulations governing these homes and standards set by HIQA. The Bill will also strengthen and modernise the registration and cancellation of registration process. The chief inspector will have the power to refuse to register, attach conditions to a registration, or cancel a registration in the event of non-compliance with regulations.

This Bill will demonstrate that the Government is making patient safety a driver of substantive reform throughout our health services. We will set new standards, strengthen inspections and gather and publish new information on outcomes as we have done already on hygiene in hospitals, for example. We will ensure that patients' voices are listened to, both the complaints and the compliments. Patient safety will help us to make the right decisions on the best organisation within hospitals and the best organisation of our hospitals. We will provide as many services as possible, as locally as possible and as safely as possible. Patient safety and quality outcomes will inform the investment in and organisation of our new cancer control strategy. Everyone working in health can unite around this agenda of patient safety.

It is an agenda for constant change and improvement that requires clear leadership at all levels of our services. As Minister, my job is to keep patient safety at the top of the political agenda, to bring forward policies and legislation to increase safety and quality. I look for leadership from consultants, the top clinical decision-makers on a change agenda driven by patient safety. I also look to other leaders in the medical, nursing and other professions in health who are well positioned to take on leadership roles for real and lasting improvements in safety and quality. I also encourage patients and their advocates to play their part in embedding safe care in our systems. Reliable and accurate information on what is happening in our systems is a critical prerequisite for effective action. HIQA will help us to improve our data collection, analysis and results dissemination so that learning to prevent clinical error is shared across our health services.

We must examine fundamental issues such as how our hospitals are designed and constructed so that we can tackle problems like hygiene more easily. All areas of service provision should be continually reviewed to ensure that safety is provided for our patients. This can include, for example, the broad area of equipment design. Some disciplines such as anaesthesia have shown what can be achieved by better design of equipment such as anaesthetic monitors. These changes have resulted in dramatic reductions in anaesthetic errors. Apart from the harm avoided and the lives saved this has also led to fewer malpractice claims and lower insurance costs. These principles can be applied in many other disciplines.

To reduce clinical error we need to tackle the culture that pervades many clinical settings. Rigid hierarchies can inhibit junior staff from highlighting areas of possible error. A culture of blame and shame makes it harder for individuals to admit error and learn from it. A culture of safety is based on accepting that the working environment and the wider organisational context are key determinants of clinical error. By moving from a blame culture to a safety and learning culture we will improve critical incident reporting and analysis. Interdisciplinary training could help to break down possible communication barriers in clinical settings.

Patients, their relatives and carers must be central to our efforts to minimise harm and we must develop mechanisms where they are empowered to point out any possible errors or care deficiency without fear of the consequences. I encourage patients to adopt a working motto such as "Nothing about me without me" and assert their right to comprehensive information on how their condition is being treated.

The inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda chaired by Judge Maureen Harding Clark was established by the Government in 2004 following the decision of the Medical Council to remove Dr. Michael Neary from the register of medical practitioners after finding him guilty of professional misconduct. The Government decided that a further inquiry into the matters raised by the Medical Council was necessary. Since the publication of the report in February 2006, I have met many of the key stakeholders including Patient Focus, the HSE, the Medical Council, and the management and medical board of Our Lady of Lourdes Hospital.

The recommendations in the report are informing the policies the Government and the HSE are implementing in a number of areas including the preparation of the new medical practitioners Bill; the new contract for hospital consultants, with particular emphasis on the development of clinical leadership within the profession; and changes in management systems and quality assurance within hospitals to develop care delivery through managed care networks.

The report will help to inform the continued approach of my Department to these important issues. As for the hospital today, the inquiry found that the possibility of the maternity unit falling behind in current practice is now remote. However, we cannot be complacent in respect of this finding and must ensure that all necessary measures are taken on foot of the report's findings. There have been major changes in practice in the maternity unit to minimise or entirely remove the climate of isolation referred to in the Medical Council report. The incidence of peripartum hysterectomy has fallen dramatically and now accords with national rates.

There is now a team of consultant obstetricians to facilitate improved clinical audit and clinical governance. The current consultants have developed a strong collegiate approach to practice. The unit is moving forward and offering care that is evaluated against known benchmarks.

The inquiry found the medical board and the new consultants to have the motivation, skills and energy to move the hospital forward as a fully recognised teaching hospital with specialist registrar training in all departments.

As I noted earlier, I met the medical board following publication of the report and was impressed with its obvious commitment to ensuring the very highest standards of care prevail in the department.

The Health Service Executive published the report of the independent inquiry into the death of Patrick Joe Walsh in Monaghan hospital on 7 September last. The report details the obstacles that arose when trying to secure Mr. Walsh's transfer from Monaghan to either Our Lady of Lourdes Hospital, Drogheda or Cavan General Hospital. Since the death of Mr Walsh, a new protocol regarding patient transfer has been put in place. It provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda should be granted and processed immediately.

International best practice demonstrates that patients have better outcomes when treated in hospitals with appropriate numbers of specialist staff, high volumes of activity and access to the correct diagnostic and treatment facilities. I am concerned that at present, some patients are being exposed to increased risk because specialist services are being provided in some hospitals that lack the necessary critical mass of activity and patient throughput. Patient safety and quality must be paramount and must be the key drivers in the reconfiguration of our acute hospital services. The policy of the Government is to provide safe, high quality services that achieve the best possible outcomes for patients. This will mean rebalancing service delivery in order that those services that can be safely delivered locally are so delivered and that more complex services requiring specialist input are concentrated at regional centres.

Is the Minister sharing time?

Yes I am.

The HSE has recently established a steering group to implement the Teamwork Management Services report and to oversee a programme of improved safety and standards across the acute hospital network in the north east. This group is led by the national hospitals office and the project group is led by Dr. Eilis McGovern, a consultant surgeon from outside the region. The HSE has begun the process of reorganising its acute services in order to further the implementation of the Teamwork Management Services report, as well as the report of the independent inquiry into the death of Mr. Walsh.

In conclusion, the Government is embarked on the detailed implementation of reform, new legislation and funding, as well as a new culture of safety in health. It will set standards and strengthen inspections and registrations. It will also do all it can to safeguard a culture of patient-focused care, a culture that is not mechanical but is deeply rooted in a humane and ethical commitment to respecting and valuing human dignity.

Health services are delivered by human beings and human beings make mistakes. As medicine is not an exact science, some level of error is probably unavoidable. The challenge facing us is to reduce or eliminate avoidable mistakes. I have outlined many current developments as well as those that are under way, which should contribute enormously to protecting both patient safety and patients' rights.

I thank the Minister for sharing time. I welcomed the decision of the Health Service Executive to publish Professor Des O'Neill's report. I note the Minister has welcomed its publication and has stated the HSE will work to implement its recommendations. As I have stated at other times, I know Des O'Neill very well. He works in Tallaght and took care of my father during his last illness. I value his work on behalf of elderly citizens. While I should not be struck by such matters, I noticed that the Minister mentioned Eilis McGovern. It reminded me that when I underwent heart surgery, she was the lady responsible. It is good to see she is doing other things.

The issue of safety in the delivery of health services lies at the heart of any care system which has the confidence of the people using those services. While the health sector is one of the most complex areas of activity in any country it must, by its very nature, command the confidence of those who use it. To obtain that confidence, the measures set out by the Minister are fundamental. There must also be a framework of ethical behaviour by service providers and professionals if the trust of patients is to be secured. Governance, in the broadest sense, is critical if any system is to put in place the correct elements that will create the necessary framework of good behaviour.

I will describe some of the developments regarding these elements as they affect the HSE and key professional bodies. At the outset, it must be acknowledged that those who work in the health services and have real concerns regarding the safety of patients, otherwise known as whistleblowers, should be listened to and their position protected when genuine concerns are expressed. This is a complex area and one must be careful that different views regarding a problem are considered in a structured way. While the issue of staff who disclose concerns on patient safety has been under examination in the Department of Health and Children, the complexity of the matter has meant it has not proved possible to draft an appropriate provision in time for inclusion in the health Bill. However, I understand the Department continues to develop legislative proposals on this issue, which I welcome.

A number of statutory and other provisions are already in place in respect of governance in the health system. For example, under the statutory frameworks governing health professionals, there are provisions concerning the ethical conduct of such professions. The Health and Social Care Professionals Act enacted last year provides for the establishment of registration boards for each of the professions covered by the Act, the functions of which include giving guidance concerning ethical conduct and support to those registered with the boards in respect of the practice of their professions.

The Medical Council has a guide to ethical conduct and behaviour which deals with matters of confidentiality and consent under circumstances in which there are exceptions to the rules of confidentiality and in which doctors should report on the behaviour and competence of other doctors.

Section 25 of the Health Act 2004 provides that members of the board of the HSE, members of any committees of the board, employees of the HSE or any person engaged by it as an adviser shall maintain proper standards of integrity, conduct and concern for the public interest. In order to ensure the implementation of such standards, the HSE is obliged to draw up a code of conduct for employees not covered by standards applied by the Ethics in Public Office Act, as well as advisers and their employees. Such a code must indicate the standards of integrity and conduct to be maintained by them in performing their functions.

Furthermore, section 35 obliges the HSE to draw up a code of governance that will include guiding principles applicable to the HSE as a public body. The Department issued a framework document for corporate and financial governance for the HSE and requested the executive to draw up a code of governance in line with it. The framework document highlighted specifically that in 2001, the Government approved a code of practice for the governance of State bodies under which such bodies are obliged to set out their objectives in respect of the maintenance of proper standards of integrity and disclosure of confidential information. Under the 2004 Act, the HSE is obliged in its annual report to indicate its arrangements for implementing and maintaining adherence to the code.

The HSE submitted a draft code of governance to the Department in September 2006, which is currently under examination in the Department.

The proposed medical practitioners Bill will introduce more streamlined and transparent procedures for the processing of complaints. It will integrate registration, education and training, ongoing competence and fitness to practice processes. It will define clearly the responsibilities of the Medical Council regarding the education and training of medical practitioners. I understand it will provide for the first time a legal framework for the Medical Council's implementation and administration of a system of competence assurance. It is intended that the new legislation will make continuing professional development and education compulsory for medical practitioners. The new medical practitioners legislation will be complemented by the Health and Social Care Professional Act, as well as other forthcoming legislation governing nurses, midwives, pharmacists and dentists. This legislation will have the common purpose of ensuring robust governance, clarity of procedures and formal systems of accountability. Such measures are aimed at the protection of the patient, while simultaneously recognising the need for due process in respect of the processing of allegations against health care professionals.

The purpose of the proposed nurses and midwives Bill is to modernise and strengthen the regulatory framework for nurses and midwives. I understand it will update and amend the Nurses Act 1985 to reflect and respond to the significant changes experienced by the health services and nursing and midwifery professions since 1985. It will seek to ensure that people are better informed and protected and will have increased confidence that the nurses or midwives caring for them are properly qualified, competent and in good standing with An Bord Altranais, the independent statutory body responsible for the regulation of these professions. The draft heads of this Bill include proposals for greater public interest representation and more public transparency, accountability and opportunity for redress. Changes to registration requirements are proposed, as are improvements in the fitness to practise procedures and the promotion of the highest standards of professional performance by nurses through making provision for competency assurance.

In conclusion, it is clear that much work is being done and will be done to improve the safety of patients in our health system. The Opposition has given the impression that nothing has been achieved in this area and, as the Minister indicated, nothing could be further from the truth. A structure is being put in place which will have national application——

I am surprised the Deputy fell for that.

Deputy O'Connor, without interruption.

I am surprised that Deputy Kehoe would pick on a humble backbencher at this hour of the night. This structure will cover the key programmes delivered by the HSE.

A humble backbencher——

This is the first time——

Deputy O'Connor, without interruption, as he is running out of time.

We are putting in place a patient safety structure that is a comprehensive system, including information needs, quality assurance and value for money. Considerable progress in respect of inspection of nursing homes is being made by the HSE. However, there should be some acknowledgement of the considerable work being implemented by the various bodies mentioned by the Minister and me. I am glad that such prominent members of the Opposition and would-be Ministers are here to listen.

Wishful thinking.

I did not say in which decade. I have no doubt that the results of all this effort will bring about a first-class safety environment to protect the health of all our people.

I have probably never made a speech in Dáil Éireann, particularly in respect of health, when I did not mention Tallaght. However, there will be other nights to mention Tallaght and other occasions to talk to the Minister.

I wish to share time with Deputies Breeda Moynihan-Cronin, Kehoe and Connaughton.

Is that agreed? Agreed.

I am not scoring any political points but I must point out that the way we treat our elderly people in the health service is disgraceful. We all learned about the issues relating to Leas Cross on television and in the report on the nursing home, but the issue is wider than this. I am talking about elderly people who are made to feel they are burdens on the system. They are described as bed blockers and put under pressure to move out of acute hospitals when there is no place for them to go, when they cannot be looked after at home and when there is no public bed for them and no affordable bed in the private nursing home sector. If this debate tonight, the motion moved on behalf of Fine Gael and the Labour Party and the Minister's response makes a difference to these elderly people, we will have done a good job.

I visited a house last Saturday morning and spoke to the elderly couple who lived there. The wife's brother is a single man who is in an acute hospital. The family is being put under extraordinary pressure to move this man out of the acute hospital setting and into a nursing home which is 15 miles away from his home. The family does not have money and does not have access to public transport. The man does not have children and, having lived his life and contributed to society, he is being treated as a burden on the system. There is no public bed of which he can avail. The nursing home subvention combined with his pension is not adequate to pay for the nursing home to which the acute hospital wishes to shunt him. The family is holding out but is receiving telephone calls every day from the acute hospital asking it when it plans to move this man out of his hospital bed. That is appalling in this day and age and we must take urgent action to deal with it.

Many people find themselves in such a situation. They are being shunted into private nursing homes which they cannot afford. Earlier today in the House, the Taoiseach said that they are being paid for and that this is not happening, but in my area there is a very large gap between the maximum subvention anyone can receive with enhanced subvention plus his or her pension and the cost of nursing homes. The families involved are being put under terrible strain. I wish the Minister would do something about this. I note that in her speech, she declared that she would provide financial support for people needing long-term residential care so that care is affordable.

It is not affordable in my constituency. I received some figures recently. The number of beds in the public system in the western region of the HSE, which ranges from Donegal down through Deputy Connaughton's constituency to my constituency, is 2,235. This number must cater for all dependent elderly people in the west, which has a very high population of such people. This is simply unacceptable.

We depend on the private sector. We do not provide enough subvention. The private sector essentially aims to make money although I acknowledge that there are some very good private nursing homes. I have had experience of such homes through witnessing the care given to members of my family. However, these nursing homes do not have the staff to cater for many very dependent elderly people who are being pushed into these homes. As a nation and a society, we must provide the necessary public funding that will provide publicly-funded beds for those elderly dependent people who do not have money of their own and who do not have immediate family with money of their own. Many of these cases involve single people who do not have children who can take the slack in terms of cost.

I hope the Minister addresses this issue, which is one of the most serious issues in the health system. I have not referred in detail to the specific issue raised by the Leas Cross report in the amount of time available to me, but what took place in Leas Cross is a symptom of what is happening. We have become very dependent on private nursing homes to deal with our elderly people and are essentially relying on the profit motive to address the needs of our elderly people in our public health care system, which is wrong. We need to redress the balance and provide public beds. I hope the Minister provides public beds with proper public finance to look after our elderly people. This is essentially the kind of health care that the Labour Party stands for, will fight for and, if elected to Government, will implement.

I welcome the opportunity to contribute to this debate. Unfortunately, I have only a few minutes to raise the points I wish to make. Leas Cross has prompted much soul-searching on all sides of the House because if we are to be honest, the care of the elderly reflects on all of us. I have had personal experience of nursing homes as my parents lived in a nursing home in Killarney prior to their deaths. The care they received went above and beyond the call of duty. Leas Cross has had a negative effect on the staff, patients and families connected with nursing homes which are well run. Everybody is worrying now. It is important to point out that not every nursing home is like Leas Cross, although a good few homes are.

Inspectors of nursing are not entirely to blame either. In my area, unannounced inspections of nursing homes have been taking place for the past 20 years. Inspectors can call to a nursing home to inspect it during the morning, afternoon or night. However, inspectors have no legislative back-up to enable them to do anything if they find anything wrong. It was outrageous for the owner of Leas Cross to state that because he was not a medical man, he could not be sure what was going on in his nursing home. These owners charge considerable amounts of money and it is their responsibility to ensure that their patients are looked after properly. When nursing homes are found wanting, they should face significant fines. Many of the people who built nursing homes did so for tax relief and to make money, and the only way to hit them is through their pockets.

Hear, hear.

We must impose significant fines in such cases. I acknowledge that it is terrible to have to do so but we must look after our elderly people.

I agree with Deputy O'Sullivan's comments about the enhanced nursing home subvention. I experience difficulties with this subvention every day. People may receive the full enhanced subvention in Dublin but the people in my constituency of Kerry South are struggling.

I spoke to a woman by telephone this morning who was looking after her father and mother-in-law. She applied for the carer's allowance and was informed she was entitled to an allowance for one of them because a distance issue arose. She must now choose which relative to care for and there is no one to care for the other relative. I will raise with the Minister for Social and Family Affairs the need for some leeway in this respect, particularly in rural areas where people can travel ten miles in a shorter time than they can travel the same distance in Dublin. A carer can look after two people. It is better for a family member to look after a person who needs caring than for that person to have to go into a nursing home. More flexibility is required in regard to the carer's allowance. I ask the Minister to raise this issue, as it is all part of the package. If more people cared for family members at home, fewer people would be in nursing homes.

I reiterate the point I made about the penalties that should be in place. If inspectors find something wrong in a nursing home, will the Minister give an assurance that a large penalty will be imposed?

I support the provision in the motion to facilitate whistleblowers. Without whistleblowers in private or public nursing homes, hospitals or elsewhere who will blow the whistle on the shoddy treatment of a person we cannot expect to know what is going on. I fully support the provision in the motion to facilitate whistleblowers.

I thank my colleagues, Deputies Twomey and McManus, for tabling this motion and I appreciate this opportunity to speak on it. It has been a dark number of months for the Department of Health and Children, the Health Service Executive and, in particular the Minister, Deputy Harney. She has failed the people, patients, families and everyone else involved in nursing homes.

I am disappointed that the Minister, whom I admire, has had this report since June; it is now November and she has failed miserably to take any serious action on it. She can promise the putting in place of any social inspectorate, but the only measure that will make a difference to a nursing home or to people in care is an totally independent inspectorate to reassure families that their mother, father, aunt or uncle are safe in the care of a nursing home.

It will be independent.

This is the only measure that will make a difference.

I said it will be independent.

It needs to be totally independent of the HSE and the Department.

It will be independent.

The Government is brilliant at giving tax breaks and I very much welcome them——

Can I advise the Deputy that it will be independent——

The Minister should let me finish, she can contribute in her reply to the debate tomorrow evening.

Obviously it will be set up on a statutory basis and it will be independent.

I very much welcome tax breaks but there is no point in having them unless a mechanism is put in place to ensure that nursing homes are inspected. More people are working in the Minister's office than there are inspectors of nursing homes.

That is not true.

It is true.

How does Deputy Cregan know that?

That is not true.

Allow Deputy Kehoe to continue without interruption.

I am disappointed that four Ministers, namely, the former Minister, Deputy Martin, the former Minister of State, Deputy Callely, the Minister of State, Deputy Power and the Minister, Deputy Harney, failed to take any serious action to address this issue over the past number of the months.

That is not true.

Allow Deputy Kehoe to continue.

It is okay to blame the HSE and its management but somebody must answer the questions about who was responsible for what happened in Leas Cross and who was held responsible. The Government's attitude is that it is okay to pass the matter on to the Garda; it will pass the buck until after the general election because it will take so long for the Garda to carry out the investigations that the general election will be over and done with. The Members on the Government side of the House do not care about elderly people or elderly patients in nursing homes.

It is great for the Government to say that it has spent money on the elderly and on X, Y and Z, but why are people coming to my clinic every week complaining about nursing home subventions, the carer's allowance, the home help service, occupational therapy services and the waiting list to be admitted to a public geriatric hospital? If the Government spent all this money in the health sector, why are these people waiting for the delivery of these services?

For example, all the family members of an elderly constituent who is a patient in County Wexford are looking for is a seat for a bath. This elderly man has been told he will have to wait five or six months for it because no occupational therapy services are available in the county to assess him for this seat for the bath. He does not want anything else, and this aid will cost only €500 or €600. There has been too much red tape. The Government has failed miserly on this count.

I was surprised that Deputy O'Connor supported the Government on this motion, as I thought he represented the interests of people at the grassroots.

A total of 105 people passed away in Leas Cross over a short period of time. That is disastrous. I have no doubt similar conditions are to be found in other nursing homes throughout the country because there is no inspectorate in place to check what is happening in them. However, there are some good nursing homes, including in my county. I am not saying this to frighten or alarm people but one will always know a good or a bad nursing home from the minute one walks in the door. One will recognise a good nursing home on entering it, one that provides genuine care, 24 hours a day every day of the year.

The Minister and the Government have failed miserly in this area. I would like serious action to be taken that will make a difference and that will reassure patients and their families. Families pay €600 to €700 a week to keep their elderly mother or father in a nursing home. They expect care of a 100% standard to be provided and in some nursing homes they are not receiving that.

I want to add my voice to the debate on this motion. I heard what the Minister said and her defence of her amendment, which was stout and staunch. I was surprised to hear it but I am long enough here to know that is exactly what she would do.

The Government has come out on several occasions recently and asked what are the policies of the alterative government and said it has none. The Minister has one of them tonight. She has a very well thought out action plan and proposal by Fine Gael and Labour. The Minister and the Government can have their view, but there will be a day next May or June and the people will decide on this issue at the end of the day.

They will.

The Deputy will get a chance to contribute. An opportunity will be given to find out what the people of Ireland want and who they trust. Whatever about politicians, when a problem arises in the health service in the future and given the track record of the HSE now and since it was established, if the Minister thinks that the people will allow the HSE to judge itself, she is in for a surprise. The ordinary people will not accept that on any account. No matter how she dresses it up, who is involved or whatever is the commission within the HSE, if a body is not set up such as the one which is proposed in the motion, the confidence one would normally expect will not exist. Problems will always arise in the health service and people should be confident they will be dealt with. I accept the Department of Health and Children is not an easy Ministry, but we have moved far beyond that point now.

If the exposé of Leas Cross had not happened, would there be people in Leas Cross today? There certainly would. It was not within the remit of the HSE. Unfortunately, I have to say to the Minister, although I did not think I would have to, that I do not believe she would have done anything about it had it not been exposed. People could not believe that such a thing could happen in a so-called civilised country.

No matter how the Minister camouflages the facts, ample opportunity was available for her inspectors to have the legal background necessary for them to do their job. However, the Minister did not do that, neither did the Government and for all I know it may not be done for the next 12 months. If the Government could not act on an issue such as this that was exposed to 3 million or 4 million people on a "Prime Time" television programme, what would we expect in the case of lesser concerns, concerns that people do not know about? What does the Minister think people are saying tonight when they hear her say she has such confidence in a body other than that which we propose? I thought that this motion would be accepted by the Government. I saw no reason the Government would not do so.

Meetings are organised throughout the country to discuss subventions for private nursing homes. Recently, I attended the meeting in Galway as did hundreds of people. The issue is that the sums do not add up. The old-age non-contributory pension is €192 and the subvention in the west is €190. That is approximately €358 or €360. Private nursing home charges are €500, €600 or €700. From where will the difference come? How are families expected to keep a father or mother in a nursing home if that is the only financial help they will receive?

We do not have State-run homes. In my county, daily announcements are made on investment in St. Brendan's, Loughrea. However, the number of patients was 200 but by the time the Minister is finished only 80 patients will remain. It will certainly be a more modern facility but the number of patients has decreased. Everything goes against the patients.

Although it is not mentioned much, the issue of patients requiring transfer demonstrates the need for a patients' safety authority. On many occasions in my constituency, seriously ill patients must be transferred to a hospital with better technology. Between the consultants, hospital managers and bed managers, no one is able to tell the family of the sick person what is happening. That is allowed to continue for four or five days and no one will take responsibility.

Debate adjourned.