Dáil Éireann debate -
Wednesday, 14 Feb 2007

Vol. 631 No. 4

Nursing Home Eviction Notices.

Mr. Costello

I welcome the Minister of State, Deputy Parlon, although I would have preferred the Minister for Health and Children to have been here so that she could hear first hand what is going on in the nursing homes for which she has responsibility. The next of kin of two of my constituents recently received curt letters from St. Margaret's nursing home telling them that two elderly people would have to leave the home. The letter states:

Dear X

It is with regret that I am giving you notice to find alternative accommodation for Mary.

The Health Service Executive have been informed of this decision and will help you find alternative accommodation for Mary.

If I can be of any assistance please contact me on [phone].

Your Sincerely

The signatory of the letter did not identify his or her role or position in the nursing home. It was a simple, typed circular letter with blank spaces in which the Christian names of the addressee and the patient could be hand written. It was not even a decent mail merge. There was no explanation as to why the elderly patient had to leave so abruptly. There was no reference to Mary's husband who has multiple medical problems and who has been living in the same nursing home for the past seven years. There was no expression of appreciation for those who had been resident in the nursing home for years and who had handed over their savings and pensions or for their families who visited them there regularly.

Landlord and tenant relationships are regulated by law. The landlord is obliged to specify a period of time as statutory notice before he or she can ask the paying tenant to leave. Apparently, no such rights are available to patients in nursing homes.

My constituents are husband and wife. It appears that one may be allowed to stay and one may have to leave. That gives rise to problems. If it is the case that the HSE has instructed the nursing home to take a particular course of action — we have seen reports in the media on this nursing home and on others in respect of which the HSE is suspending their activities — then it should explain that to the patients and the next of kin and ensure a patient-friendly approach is taken when dealing with the problems. In any set of circumstances, the HSE should supervise and ensure the actions of a nursing home are carried out within proper agreed parameters.

Will the Minister for Health and Children spell out the particular circumstances surrounding the removal of these and other patients from St. Margaret's nursing home which has a total of 26 patients? So far, we have been told ten public patients will be moved but there is no sign of private patients being moved. What exactly is the situation? What steps will be taken by the Minister's Department to facilitate these patients, who have been asked to move and whose next of kin have been informed, in new accommodation? Will she indicate what steps she proposes to take to ensure this does not happen again? It causes enormous distress to patients and family members who do not know what is going on in that particular nursing home. They do not know why their next of kin is being moved out at short notice.

The nature of the letter written is an absolute disgrace. We need a decent dignified service and the Minister of Health and Children is responsible for ensuring that. I hope the Minister will take that on board and that we will get a comprehensive answer on these matters.

Mr. Parlon

I am taking this matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney. I thank the Deputy for raising the question as it provides me with an opportunity to outline the background to the current situation in regard to St. Margaret's nursing home and the action taken by the Health Service Executive.

Government policy is to develop and improve health services in all regions of the country and to ensure quality and patient safety. The safety and well-being of older people living in nursing homes is of critical concern. Quality care and patient safety come first and all patients should receive the same high standard of quality assured care. The present standards for nursing homes are set out in the 1993 Care and Welfare Regulations. Under section 9 of the regulations, regarding the discharge of patients from a nursing home, the legislation states: "Where the registered proprietor or the person in charge intends discharging a dependent person, they shall inform the person and the person nominated to act on the person's behalf, the date of the proposed discharge, the reasons for the discharge and give fourteen days notice to make alternative arrangements."

On 22 November 2006, the HSE suspended new public admissions to St. Margaret's nursing home near Rivermede in north County Dublin. This followed a series of inspections by HSE. The home was found to be in breach of the 1993 Care and Welfare Regulations. The imposition of such suspensions is in line with recent public assurances by the HSE that, where concerns are raised by inspectors about a private nursing home, no beds will then be contracted by the HSE with that home until the issues are rectified. Furthermore, the home has been advised not to take in privately referred admissions during this period.

On 8 February 2007, ten residents were asked by the owners of the nursing home to find alternative accommodation. It is important to note that it was the home and not the HSE which made this decision. The HSE set up a multidisciplinary committee, which met on 12 February, to work with patients and relatives to find alternative accommodation. It will continue to work with patients and relatives and is due to carry out further inspections on the home in the near future.

It is also important to note that the HSE inspection team carried out a risk assessment in this nursing home and the current assessment is that there is no immediate risk to any resident in this home.

An expert working group chaired by this Department developed and published, in January 2007, draft standards which will apply to all residential care settings - public, private and voluntary. The draft standards have been formally referred to the interim health information and quality authority, iHIQA, which will initiate a short, focused consultation process and then finalise the standards for use in the inspection process to be carried out by the social services inspectorate. The interim health information and quality authority has already established a group to finalise the draft standards and it held its first meeting on 30 January 2007.

As I have already mentioned, the Nursing Homes (Care and Welfare) Regulations 1993 outline the standards that currently govern private nursing homes and inspections are carried out based on these standards. These regulations apply to private nursing homes only and do not apply to public nursing homes at present. However, as I outlined previously, when finalised the new standards will apply to all residential care settings.

In addition to the work undertaken on the draft standards by the Department of Health and Children, the HSE has also taken steps to improve nursing home inspections. A working group was established in July 2005 by the HSE to examine the issues of inspections and registrations of private nursing homes and to standardise the inspections process nationwide. A HSE working group produced a report in July 2006 on nursing home inspections and registrations which currently underpins the inspection process. Since July, the inspection reports have been made available on the HSE's website. In addition, all inspections are now unannounced and nursing homes are now inspected at least twice a year.

It is clear that this Government is committed to ensuring that residential care for older people is safe and of the highest quality. As I have outlined to the House, the Department of Health and Children and the HSE continue to work on a number of fronts to advance this critical objective.

Hospital Staff.

Ms Lynch

I would have preferred the Minister for Health and Children to have been present but I appreciate the attendance of the Minister of State. The issue I wish to raise concerns a facility in Cork which is due to open on 24 March 2007. Cork has been well served by four maternity units and three in particular, the Bon Secours Hospital, St. Finbarr's Hospital and Erinville Hospital, which are very highly regarded and have provided a service second to none for expectant mothers in Cork for longer than anybody in the House would care to remember. It was decided that, to provide a safer service for pregnant mothers, all the maternity services were to be combined, on the grounds that all practitioners in the area would be gathered under the one roof.

We have a magnificent new building with 144 beds. It is estimated that it will deliver 7,500 babies per year and experts tell me this will quickly rise to 8,000 and more. It has been described by the local HSE as more of a hotel than a hospital, with birthing suites and other facilities we would expect in the modern world. However, there is one fly in the ointment, namely, the staffing levels which experts consider to be adequate to ensure safe practice are not being put in place. The HSE southern area commissioned a study by an expert in midwifery from England, Marie Washbrook, who considered the type of delivery to be expected in Cork, the numbers involved and the population base. She concluded that to deliver a safe service in Cork, there was a need for 383 midwives. At present 317 are on offer and they are not all fully trained, some of them being student midwives.

Midwives in Cork are very good and decent women and any woman who has been attended to by one will say that they are exceptional people and very professional. They are prepared to carry a number of trainee midwives to bring up the staffing levels. A midwife service course was supposed to be offered last year but was cancelled and it now appears it will not just be student midwives who make up the numbers but care assistants and general nurses. This is simply not good enough. A director of midwifery was appointed and left because she was expected to report to a general nursing director, but everyone knows midwifery is a separate profession and has a different agenda.

It is hoped the director of midwifery who was appointed to run the facility will take delivery of midwifery services in Cork in many new directions, including providing a service for people who want home births or to have consultations at home but deliver their babies in hospital. It was never intended, however, for the midwifery service to be dependent on the general nursing service. On 24 March, the Minister for Health and Children will cut the ribbon on a beautifully decorated facility in Cork where no service is available because staffing levels will not be of a standard that midwives in Cork feel will ensure a safe service. As a result, they are refusing to transfer.

Even at this late stage I call on the Minister to delay her visit to Cork to open the hospital and on the Government to engage with the Irish Nurses Organisation to ensure the service delivered to pregnant mothers is safe and one of which we can all be proud.

Mr. Parlon

I am replying to this matter on behalf of the Minister for Health and Children, Deputy Harney. I welcome the opportunity to set out the position on the issue raised by Deputy Lynch.

The Minister is committed to safe maternity care for women and their babies. The opening of Cork University Maternity Hospital represents the single largest investment in obstetric care since the foundation of the State. To date, €75 million has been invested in developing the new infrastructure which provides a state-of-the-art environment with a full range of birthing options and choices for mothers and their families.

Funding has also been provided for a new national perinatal and epidemiology centre in CUMH. This will allow unusual trends in childbirth to be quickly observed and, most importantly, acted on to ensure that services for mothers and babies born in Ireland are based on best possible research.

The new hospital is designed to cater for the current birth rate of 7,200 births per annum as well as gynaecology services currently provided over three sites — Bon Secours Hospital, St. Finbarr's Hospital and Erinville Hospital.

The transfer of maternity services to the new Cork University Maternity Hospital will facilitate the provision of a 24-hour, on-site, on-call consultant-provided maternity service. This will lead to better patient care and perinatal outcomes, improved risk management and clinical governance, and fulfil the Government objective of medical services being consultant-provided rather than consultant-led. Another key efficiency in the amalgamation of services will be seen in the development of a single citywide service with an out-of-hours on-call roster, rationalising the service to a single 24-hour cover rota.

Under the Health Act 2004, which provided for the establishment of the Health Service Executive on 1 January 2005, the HSE is responsible for managing and delivering, or arranging to be delivered on its behalf, health and personal social services. The HSE, therefore, is responsible for the midwifery-nursing staffing at the new Cork University Maternity Hospital, CUMH. Of all the disciplines involved in the delivery of health care, nurses and midwives have the most contact with the patient. As a group, nurses and midwives are fundamental to improving the care environments for patients.

I am aware of the concerns raised by the Irish Nurses Organisation about midwifery-nursing staffing levels at Cork University Maternity Hospital. I have been informed that HSE management has been involved in detailed negotiations with the INO on behalf of the midwifery and nursing staff who will transfer to the CUMH on 24 March next. The HSE has created 264 new additional posts, of which 146 are midwifery-nursing posts for the new Cork University Maternity Hospital, to cater for the same number of births currently provided for in the three existing locations. When the new Cork maternity unit opens it will have a midwifery-nursing complement of 375.5 full-time positions — 304 midwives, 7.5 nursery nurse positions and 64 student midwives. Twenty student midwives commenced the new undergraduate programme in 2006 in University College Cork, and as university students, they are not counted in the staffing numbers. The full midwifery staff complement will be 383 by the time all services are introduced on a phased basis by next December.

The HSE has internationally benchmarked staffing levels for the new CUMH. Recommendations from the British Paediatric Intensive Care Society as well as those of international midwifery expert, Marie Washbrook, from Birthrate Plus, have been taken on board.

I have also been informed that the HSE remains willing, as previously confirmed to the INO, to have a prospective review of midwifery-nursing staffing levels carried out once the new facility opened. It is in line with global best practice to conduct such studies once the new "patient pathways" and midwifery workload can be identified in the new environment.

Senior management has been engaged since January 2005 with a comprehensive industrial relations agenda covering all unions and representing all grades of staff. The HSE has informed me it is only in the past few days that the INO has agreed to refer any of its concerns to the Labour Relations Commission despite management's persistent requests to do so at an earlier stage. I understand a conciliation conference has been arranged by the LRC for 21 February.

I am confident the extensive range of measures taken by the Government and the HSE will continue to address effectively the midwifery-nursing workforce needs of the new CUMH. The HSE has reassured me that at all times management has been open and transparent regarding the transfer of service and every effort has been made to integrate staff from all three locations — Bons Secours Hospital, Erinville Hospital and St. Finbarr's Hospital — before they transfer to the new Cork University Maternity Hospital.

I am confident the new CUMH will provide a much enhanced maternity service to mothers and their families in the southern region.

The Dáil adjourned at 10.45 p.m. until10.30 a.m. on Thursday, 15 February 2007.