I would like to welcome our friends from Cavan in the Visitors Gallery, including Councillor Peter McVitty, his wife Susan and the delegation.
Nursing Homes: Statements.
I welcome the opportunity to address the Seanad on this sensitive issue. Like other Members and the public in general, I was extremely disturbed by the findings of "Prime Time" last Monday. It is outrageous that older people should be subjected to the type of environment portrayed in the programme and I am pleased that the Health Service Executive has reached agreement with the owners of the home to bring much-needed improvement into the operation of the facility.
The Health Service Executive, northern area, has assigned a director of nursing and senior nursing staff to ensure the delivery of the highest standard of patient care in Leas Cross on a 24 hour basis. A clinical governance steering committee is being established. This will be multidisciplinary and will also involve a representative of the residents' families and an independent expert. The steering committee will oversee implementation of all recommendations as above. An independent inquiry team is being established to investigate all areas of concern. The HSE, northern area, will be exploring all options regarding the future management of the home.
The agreement reached yesterday between the HSE and the home ensured that a director of nursing from the HSE began work in the home today. I have asked the HSE for a report on the latest position on the home, including the steps being taken to improve the unit. I have also received a commitment from Mr. Michael Walsh, chief executive of the HSE, northern area, that I will receive a progress report in one month's time on the operation of the action plan.
In addition to my meeting yesterday with the HSE, I wrote to the Garda Commissioner and requested that gardaí meet with the HSE as a matter of urgency to discuss any issues that might be followed up by them. I hope there will be a visible and significant improvement in the welfare of the residents of Leas Cross and a happier future for them and their families.
It has been the policy of successive Governments to maintain older people in dignity in their own homes for as long as possible, and to provide high-quality, long-term residential care for older people when this is no longer possible. It is internationally recognised that only 5% of the older population will need long-term care. However, people are now living longer lives and though most are leading healthy independent lives, the number in need of long-term care is increasing. There is demand on public long-stay places and there is a growing reliance on using private nursing home places. Many homes provide excellent nursing and care support for their residents and will continue to do so.
The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations 1993 set out the standards to which the private nursing home sector must adhere for the purpose of registration under the Health (Nursing Homes) Act 1990. The regulations only apply to the private nursing home sector and do not cover public long-stay facilities for older people. However, there was a commitment in the health strategy document, Quality and Fairness — A Health System for You, to extend the role of the social services inspectorate to other social services, including residential services for older people. The social services inspectorate will be established on a statutory basis and will be totally independent of the Health Service Executive. Its work will cover both public and private nursing homes and the Bill will be published later this year to put it on a statutory basis.
The Department of Health and Children is reviewing urgently the operation of the Health (Nursing Homes) Act 1990 and the Nursing Home Regulations 1993 to strengthen the powers available to the Health Service Executive. This will be a wide-ranging review which will have the rights and welfare of the resident as the centre of its work. It will update the Health (Nursing Homes) Act 1990 and the regulations so any issues regarding employment law, training of staff and so on are reflected in the new legislation. I intend to publish the Bill this year so we can have an open debate that will include all interested parties on a new environment for patients in nursing homes.
Information is one of the most critical issues to be covered by the Bill. It is simply not satisfactory for people not to have comprehensive information easily available on services provided in nursing homes. The new Bill will include a clear statement on easy access by the public to inspectors' reports on nursing homes. The HSE will be developing a common national approach to the inspection of nursing homes. This work will be significantly helped by the fact that the HSE is a national agency and can implement a common policy more easily than heretofore when we had ten health boards and the Eastern Region Health Authority. The work of the HSE can complement the social services inspectorate when it is established on a statutory basis and common standards of inspection are applied.
The Government's commitment to the development of a comprehensive range of services for older people can clearly be demonstrated by outlining the resources made available in recent years for service developments. Since 1997 additional spending on health care services is in excess of €302 million. In 2005 alone, it is estimated that €1,068 million will be spent on care of older people. This funding will be used for a variety of services including the nursing home subvention scheme, home care grants, home help service, an elder abuse programme and support to voluntary organisations. The Health Service Executive has piloted home care grant schemes as an alternative to long-term residential care to assist older people living at home. Older people who are being discharged from acute hospitals and those living in the community are being targeted under these schemes.
In the HSE, eastern regional area, people have been discharged from acute hospitals under the Slán Abhaile and Home First pilot projects. These programmes aim to prevent the inappropriate placement of older people in long-term care settings, including private nursing homes, by facilitating older people who wish to go home following treatment in an acute hospital with the necessary home support services; to provide a timely and well-planned discharge to older people in hospital, thus reducing the number of days spent in hospital following treatment; to prevent unnecessary re-admission to hospital; to support vulnerable older people to remain living at home; and to support families who are caring for vulnerable older relatives at home. In the HSE, southern area, a similar project called Curam has been piloted, while the Choice programme in the HSE, north-west area, also provides such a scheme. The development of a national home care grant scheme is in keeping with a key recommendation in the O'Shea report on the nursing home subvention scheme which recommended that the health services develop a home-based subvention scheme for older people as an alternative to long-term residential care. Funding of €2 million has been allocated to the HSE in 2005 to develop the scheme further.
There have been improvements in recent years in developing telephone supports for older people who may feel defenceless. The senior helpline, telephone 1850 440 444, was established with the support of the health boards in 1998 and has received in excess of 10,000 calls from lonely older people nationwide since 1999. The service is confidential and non-directive and is available throughout the State for the price of a local telephone call. The HSE indicates that there are now some 300 volunteers working from nine centres across the country. These are all older people who have gone through the rigorous training which is provided in conjunction with the health authorities.
Since 2004, the Department has allocated funding totalling €72,800 for a promotion campaign aimed at raising awareness of the telephone number of the senior helpline. The HSE informs me that this telephone number was circulated to all doctors' surgeries in the State. In County Meath, the Summerhill Active Retirement Association received national lottery funding totalling €15,000 in 2003 to produce a booklet and promote the senior helpline. In December 2003, the HSE supported an independent evaluation of the helpline. This was carried out by Dr. Eamon O'Shea of the National University of Ireland, Galway and launched by the President, Mrs. Mary McAleese, who is patron of the helpline, in 2004.
The HSE supports the implementation of the recommendations of the evaluation and this implementation is now well advanced. The senior helpline has responded to issues of elder abuse since its foundation. Volunteers have received specialised training, funded by the former health boards and provided by health service professionals specialising in the area of elder abuse, to enable them to deal with calls of this nature. Approximately 5% of calls in 2004 related to elder abuse. These callers establish a relationship of trust over a period of time with the older volunteers who take their calls and are often unable to seek external or professional intervention until they feel secure in discussing their situation.
The senior helpline has expanded in recent years and three new centres are preparing to come on line later this year. In addition, the Department of Health and Children, through the HSE, has agreed to support further expansion of the helpline hours. Later this summer the service will also operate in the afternoons, expanding from a morning and evening service. Each senior helpline centre provides support materials for volunteers, with key contact details of health services appropriate to dealing with elder abuse situations where the caller wishes for such an intervention.
The Government is fully committed to developing the services needed to tackle the problem of elder abuse. In 2003 we established the elder abuse national implementation group to oversee the implementation of the recommendations contained in the report, Protecting our Future — Report of the Working Group on Elder Abuse, which was commissioned by the Government. Funding of €0.8 million was provided in 2003, €0.75 million in 2004 and a further €0.9 million in 2005 to continue with the implementation of these recommendations.
Elder abuse is a complex issue and difficult to define precisely. It may involve financial, physical or sexual abuse, or it may arise due to inadequacy of care. It is defined in the report as "a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights". It is hoped this report, in commencing with a definition of elder abuse, will give older people who feel they are the subject of abuse in any form the confidence to report their anxieties, as appropriate, to a social worker, public health nurse, garda or any professional or care worker.
It is important that the issue of elder abuse be placed in the wider context of health and social care services for older people. As recommended in the report, multidisciplinary steering committees are being established at HSE area level to provide a common response to elder abuse throughout the State. The primary role of the steering committees is to plan, co-ordinate, support, monitor and evaluate an approach suitable to that particular HSE area. The report recommends that a clear policy on elder abuse be formulated and implemented at all levels of governance within the health, social and protection services in Ireland. The committees are in the process of developing clear policies and guidelines for the protection of vulnerable adults following wide consultations with staff. Their work is progressed through subgroups on legal aspects, policy and procedures and training.
The HSE continues to provide and develop multidisciplinary training for internal and external staff as recommended in the report. The issue of elder abuse is being incorporated into professional training courses including gerontology courses. A number of research projects are ongoing, including the examination and review of medication for older persons in continuing care settings.
In regard to the funding of long-term care, the Mercer report on the future financing of long-term care in Ireland, which was commissioned by the Department of Social and Family Affairs, examined issues surrounding the financing of long-term care. A working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established following the publication of the report. The objective of this group is to identify the policy options for a financially sustainable system of long-term care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea.
The group has been requested to report to both the Minister for Social and Family Affairs and the Tánaiste by the middle of 2005. Following this process, it is the intention that there will be discussions with relevant interest groups. In the interim, work has been carried out in a number of HSE areas on developing standards for residential care for older people. In addition, the Irish Health Services Accreditation Board has commenced work on examining the development of accreditation standards for residential care for older people, both public and private. In this regard, it is developing a pilot programme which includes both public long-stay units and private nursing homes.
It will be clear to Members from what I have outlined that the Government's commitment to older people cannot be denied. We acknowledge that we must continue to develop legislation in this area to meet the growing demand for services and that we cannot be complacent about this. This Government and its predecessor can be proud of their record to date but there is no room for complacency and we must continue with our efforts.
I propose to share my time with Senator Brian Hayes.
Is that agreed? Agreed.
I disagree totally with what the Minister of State has said. His claims regarding the Government's commitment to older people bear no relation to the truth in this matter. Once again, the Government has been found wanting and the fire brigade syndrome is in evidence. Instead of taking charge and being proactive as it should be, the Government merely reacts to crises. The purpose of any Government is to govern but there is little evidence of that. It is ironic that just as the examination of the Travers report by the Oireachtas Joint Committee on Health and Children is being finalised, another scandal is already brewing regarding care of the elderly in private nursing homes.
This situation was highlighted by Monday night's "Prime Time". However, the issue was only brought to light because of the ongoing work of a former Member of this House, Deputy O'Dowd, over seven years. He was blocked at every opportunity in his endeavours and his task made as difficult as possible, but he persisted in highlighting the issue and eventually got a result. It is even more amazing when one considers that there have been successive Ministers of State at the Department of Health and Children with devolved powers and sole responsibility for the welfare of the elderly. Why do these Ministries exist? Ministers of State presided over the fiasco of the illegal nursing home charges and now we are confronted with this situation.
What other scandals regarding the elderly will break over the next few months or years? Why are junior Ministers with responsibility for the elderly unable to supervise effectively or prevent these events from happening despite having devolved powers? Why does the Government continue to depend on Opposition Deputies and the media to bring matters to their attention before finally taking action?
The Minister of State's reaction to this matter was appalling. He discussed legislation that will be brought forward in autumn. Last Christmas, we sat extra days so that legislation on the illegal nursing home charges could be introduced. This Government has no problem in taking money from the elderly. However, we are told that it will be autumn before legislation to protect them will be introduced. Clear indications of Opposition willingness to take a shorter summer recess have not been matched.
Media reports of this story are difficult to believe. In early 2000, it was reported that the prescription of one nursing home resident had not been renewed since 1999. We hear of cases where patients receive baths or showers every ten days. Food was cleared from dinner plates and kept for use in soup or stews the following day. Some of the information contained in the inspection reports on private nursing homes over the past five years was only recently released under the Freedom of Information Act. The Government, possibly because of these reports, sought to curtail this Act. Deputy O'Dowd found it difficult to do his work because of restrictions to requests under the Act and the shortage of staff in the Information Commissioner's office.
The reaction to this matter contrasts starkly with the Government's introduction of flawed legislation to this House last Christmas. This legislation, which sought to take money from the elderly, was ultimately rejected by the Supreme Court. It is amazing that the Government will not take up the offer to sit later this summer so that legislation may be enacted. While some may say that the Government is full of hot air, it is rapidly running out of steam. Despite being in its ninth year of power, it has failed to keep legislation up to date. A revolution has occurred since 1990.
It is also amazing that advance notice of inspections is given to nursing homes. The inspectorate does not employ the legal minimum number of inspectors. It does not have power to shut down the worst offenders but must follow a lengthy legal process. Situations such as Leas Cross arose because of the inaction of this Government. Some 44 further incidents occurred in the few hundred nursing homes throughout the country.
The Government has not taken cognisance of the fact that the population is aging. A number of public beds, including 147 long-stay beds, have been closed in the western area, which has put greater pressure on the private sector and forced more people into private nursing homes. The Government bears direct responsibility for this. It has made numerous commitments in this area, including the national health strategy in 2001, An Agreed Programme for Government in June 2002 and the Sustaining Progress programme since 2003. However, it has failed to introduce clear guidelines on standards of care. The national standards which were promised in 2001 have not yet been introduced. Nursing home inspectors continue to work within limited guidelines. The reinforcement of standards of care lacks uniformity across the voluntary, statutory and private sectors. The current regulations on private nursing homes is based upon the Health (Nursing Homes) Act 1990 and the amendment to that Act passed in 2001. Power was not given to the inspectorate to close nursing homes.
The changes made by the Government to the rules for requests under the Freedom of Information Act have a direct impact on these matters. Deputy O'Dowd found that he was impeded when making his request. If a front bench Deputy has difficulty in obtaining information on nursing homes, what hopes have the elderly and their families of getting the information they require?
The Minister of State raised the issue of elderly abuse, which includes physical, psychological, financial, material and sexual forms of abuse, discrimination, neglect and acts of omission. In 1998, a working group was set up to investigate this issue and a report was commissioned. The group did not report until November 2002, when numerous recommendations were made. Unsurprisingly for this Government, few of these have been implemented. Recommended funding was in the region of €4.5 million per year but the Minister of State admits that €800,000 was provided in 2003, €750,000 in 2004 and €900,000 in 2005. Contrast these figures with the €60 million that was squandered on e-voting. I am unsure of the exact figures regarding the facility at Punchestown.
The Seanad has no problem in sitting longer hours in order to pass legislation. This case has been a time bomb waiting to explode. We should not wait until autumn to bring in legislation.
I welcome the Minister of State to this House and thank him for putting his statement on record. It was important that my party gave up its allocated time for Private Members' business in order that this two hour debate is held and Members have the opportunity to put their views of this matter on record.
I fundamentally disagree with the Minister of State's assessment of the situation. It is wrong that a Bill will be published later this year without a timeframe in terms of the implementation of an independent inspectorate. We should urgently revisit the matter because it is not the response that the country awaits. Political responsibility is needed.
This is not the first time we have learned of these matters. In December 2002, the National Council on Ageing and Older People called for an independent inspectorate. In February 2001, my party brought a Private Members motion before the Dáil which called for an independent inspectorate but was voted down by the Government. In July 2001, the then Senator O'Dowd stated in this House:
Senators might find it hard to believe that there is a nursing home in the North Eastern Health Board region that gets its patients up at 5.30 a.m., but it is true. The reason they are out of bed at that hour is that there are several high dependent patients there and there is inadequate staff to go in at 8 o'clock to get them dressed and ready for breakfast.
In March 2002, the then Minister of State at the Department of Health and Children, Dr. Moffatt, said that no arrangements are in place for an independent inspectorate but that it was "planned to rectify this by expanding the role of the social services inspectorate to cover extended care facilities for older people." That was not done. In April 2003, a report from the Human Rights Commission was clear on similar problems which occurred in two places. A cursory reply was received eight months after sending the report to the Department of Health and Children but no action was taken. In December 2004, Deputy Seán Ryan was shot down when he called for an independent inspectorate.
I put these matters on record because political responsibility should be taken. I am not aware of every problem which exists in the Department, although some were exposed in the Travers report. It is not good enough that politicians can hang senior civil servants out to dry while saving their own scalps. Nor is it good enough that three Ministers of State with specific responsibilities in the area have failed since 2000 to act to create an independent inspectorate and a more rigorous interim system of investigation to bridge the gap between the proposed statutory mechanism and the current ad hoc regime. Who takes responsibility for the failure? Is it the fault of senior civil servants? Will another assistant secretary have to pack his bags to be hived off to the Higher Education Authority? The matter goes to the heart of Government.
The Senator should read the Travers report.
I will not interrupt Senator Feeney. The Government was exposed when Deputy McManus asked the previous Minister for Health and Children, Deputy Martin, at a meeting attended by Senator Feeney if he felt responsible for the debacle. He said he did not.
Absolutely not.
Of course he was responsible.
He was the Minister for five years.
It is a disgrace.
The Senator was not at the meeting. He should read the report.
A Chathaoirligh, I have not interrupted anyone.
The Senator should read the report.
I have read it.
There is a need to interrupt when the Senator is talking baloney.
Senator Feeney will have a chance to respond.
Senator Feeney might want to justify to the families involved the fact that three separate Ministers knew of the matter but did nothing for the past five years.
I have no difficulty justifying that.
I will not, quite frankly.
The Senator should wait until the report comes out and then read it.
The key issue is a systematic cover up at the heart of our Government because Ministers do not want to take responsibility. Civil servants may have been blamed and shunted off to other public agencies, but political truths are being brought home at the Department of Health and Children and to those with political responsibility in the Houses of the Oireachtas for decisions taken.
There is a question mark over the people to whom we are providing tax breaks to run nursing homes. Is it right and proper that someone who has made two large tax settlements with the Revenue Commissioners in recent years has been given the responsibility through a tax break to operate a nursing home facility? Our priorities are completely wrong in an area in which policy is being driven by a base profit motive. It is one of the reasons we must get to the root of the matter.
The most important reason to establish an independent inspectorate immediately is not necessarily to deal with the cases highlighted by "Prime Time" but to address the vast majority of public and private nursing homes which do good work in the community. As they need an independent inspectorate to vindicate their good names, we need legislation now rather than at the end of the year.
I welcome the Minister of State, Deputy Seán Power, to the House and thank him for attending at such short notice. It was only decided to take the business this morning. I welcome the opportunity to address the nursing homes issue and thank Senator Brian Hayes for putting it on the agenda by giving up his party's Private Members' time. The debate is timely for it is right to strike while the iron is hot. Sadly, the iron is a very hot one in this instance.
The story outlined in the "Prime Time" investigation on Monday night was shocking, outrageous and appalling. Viewers could not believe their eyes. As I watched the programme with my 19 year old daughter, there were times when I had a tear in my eye. I told her that I could imagine, given my upset and shock despite not currently having a relative in a nursing home — though I have had in the past — what people with elderly family members in nursing homes were feeling as they watched. I thought of the kind of night they would have when they went to bed. I was terribly touched and affected by the programme.
I record my congratulations to the "Prime Time" team and the programme's investigative journalist. It is not the first time they have been congratulated in the House nor will it be the last. It is wonderful to have the service they provide. I record also the appreciation of all Members for Mr. Justice Frank Clarke who did not issue a blocking injunction against the programme. As he rightly pointed out, the programme raised matters of great public importance. If it were not for Mr. Justice Clarke's actions, the Seanad would not be taking statements on the matter as Members would not have seen the programme. I look forward to Mr. Justice Clarke's final report which is due to be published on 8 June.
The most shocking aspect of the programme were the allegations that patients were receiving substandard care. While we saw graphic footage, it should be remembered that the actions are alleged. We saw that bedding was not changed when patients had wet it, while a particular patient was forced to take his medication. The most appalling aspect of forcing the patient to take his medicine was the bullying to the effect that he would have to go to hospital if he refused to co-operate. When the patient used strong language, I commended him as it was exactly what I would have done.
Where a family had paid for a night assistant for an elderly relative, no one was sitting in with the lady in question at night. When the investigator asked if the relatives knew this was happening, the answer was "No, and nobody will tell us". It was an example of fraud. The nursing home in question took money from a family and provided nothing in return. I am glad the Minister of State has brought the matter to the attention of the Garda.
Unfortunately, as a result of the broadcast, the entire nursing home sector has come under fire. We must remember that not all the apples are bad. The great majority of nursing home care is delivered effectively, caringly and compassionately in what are often very difficult circumstances. We all know people with family members who suffer from Alzheimer's disease, incontinence or other serious complaints which affect elderly people and who receive excellent care and attention in long-stay nursing homes. We take our hats off to such professionally and compassionately staffed homes.
I am glad to say Leas Cross has agreed the HSE can intervene.
It had no choice.
Today, the HSE appointed a director of nursing at the home. Quite frankly, I did not see the matter as one of agreement as the nursing home had no choice in the matter. It is only my opinion. As the HSE has also deployed senior nursing staff, it is hoped that conditions will improve. There is an onus on An Bord Altranais to consider the matter and examine the footage we saw the other night in light of the fitness to practice of the nurses involved. While care workers are not covered by the fitness to practice regulations laid down by the Houses of the Oireachtas, the behaviour of nurses involved in these matters should be examined.
I agree that it is necessary to create an independent inspectorate and that an inspector should not have to give warning of a visit. The only way we can get a true picture of conditions in a nursing home is if an inspector can simply arrive at a nursing home, knock on the door and say he or she is there to inspect a facility, warts and all. I was glad to hear the Taoiseach say yesterday that the Health (Nursing Homes) Act 1990 was insufficient and would be reviewed as a matter of urgency. Today's newspapers indicate senior civil servants consider the current legislation and regulations to have been drawn up for a different era. Who could have envisaged we would have the number of private nursing homes we have seen established over the past five or six years? The legislation cannot be rushed and must be carefully considered. We all remember when only a few short months ago——
What is there to consider if money is being taken off people?
Order, please.
I am talking about——
That is all the more reason to legislate.
Senator Browne should allow Senator Feeney to speak without interruption.
The legislation cannot and should not be rushed. I remind the Opposition of the Rostrevor nursing home on the south side of Dublin. This case was much publicised in recent months. The High Court decided the health board did not have the right to close this nursing home. Appalling actions also took place in that nursing home and the law could do nothing about it. That is why we should not rush this legislation. Let us——
That is all——
If Senator Browne persists he will be asked to leave the House.
——think it through in a careful manner. There cannot be a knee-jerk reaction every time something happens. This nursing home is one of a few bad apples but, as I pointed out, there are excellent nursing home facilities doing a wonderful job.
Nursing home developments receive significant tax breaks from the State. I am in favour of this approach, particularly given that we have an aging population. There is a great need for more facilities, especially modern facilities. Developers and management of nursing homes should be mindful of the benefits they receive from taxpayers. These facilities should be run in a manner that is acceptable to all. Mismanagement and mistreatment of patients should be dealt with severely. We should consider the withdrawal of tax breaks when a nursing home is run in the despicable manner which we recently witnessed on the RTE documentary. Benefits should be withdrawn. No more than taking money from patients' relatives, this would amount to some type of fraud. I would not be in favour of allowing people such generous tax breaks if they were found guilty of wrongdoing.
I am delighted the Minister of State referred in his speech to the issues currently being debated and discussed. As members of the National Economic and Social Forum, Senator Kate Walsh and I sit on a sub-committee which was set up to look after services for the elderly. We have looked at nursing homes, long-stay care for patients and acute hospitals. A high proportion of patients are being left in acute hospitals. I am delighted that the Slán Abhaile programme is providing for a significant number of those people to be sent home with grants and other supports to allow for care in the community. It is clear that people would prefer to stay at home to access care. We should put whatever financial resources that are available into keeping people at home. Everybody would benefit from that, not only older people but the children who will have their grandparent or other older relative around while they are growing up, which is a great benefit.
I thought this debate was on the nursing home issue and I confined my remarks to this area. The Oireachtas Joint Committee on Health and Children is just finishing a six to seven week examination of the Travers report on which it will publish a report next week. I say to Opposition Senators that if they had read——
Senator Feeney should address the Chair.
——the Travers report, they would see——
I did read it.
So did I.
——there was no political culpability. If there was any, it was a very small amount.
All it stated is that the Minister should have probed more deeply.
Order, please.
Either one accepts the report or one does not. Senator Browne referred to the length of time it took——
Senator Feeney should speak through the Chair.
Through the Chair, Senator Browne referred to the long delay experienced by Deputy O'Dowd in getting anywhere with his problems. It took him seven years. It is no wonder Fine Gael is in Opposition and not in power. It is working at a snail's pace.
That is an outrageous allegation.
It is the neglect of the Senator's party in Government that we are discussing.
He had been pursuing it for seven years——
They can give it but they cannot take it. That is their problem.
That is outrageous.
Order please. I call Senator Ryan.
He had been raising it for seven years and he was assured——
Order, please.
I am starting now, not two minutes ago when they were all shouting at each other.
The Senator will have 15 minutes from now.
Thank you very much, a Chathaoirligh. I enjoy interruptions as long as they are not in my time.
I do not enjoy them.
It is a great pity Senator Feeney decided to have a go at a committed Member of the Oireachtas who set himself the task of struggling on behalf of some of the most vulnerable people in society and who was frustrated by the system of public administration and Government. However, I should not be surprised.
The Minister of State, Deputy Seán Power, is an old friend of mine and a fellow countyman. I am sure he was celebrating like I was on Sunday night. He was given a script which has nothing to do with the issue. There is a list in here about the wonderful things that are being done for the elderly. The fundamental issue is how it is possible——
Things are being done that will never be proven.
They can interrupt away. It will not affect me in the least.
No. There will be no interruptions.
How is it possible to have a nursing home carry on like that without anybody taking action to stop it until a television programme is made? That is the issue. The rest of what is in the script is very important but it does not have anything to do with the issue we are discussing. The television programme did no more than make visual in one specific case what we all should have known and did know — if we did not want to deny it — for the past 20 years.
In 1984, RTE produced a television programme called "Public Account" which recounted horrific stories of nursing homes. Now we know what happened in 2001, 2002 and 2003. We know what the Human Rights Commission said and we also know the grand way in which the Department of Health and Children has consistently treated anybody who tried to get it to do anything. It made the Ombudsman wait for nearly a year when he compiled his report some time ago on families being made to pay for elderly relatives in nursing homes. The suggestion that this is a horrible story that nobody knew anything about, or somehow that it is the Opposition's fault that nothing was done about it, is quite extraordinary. Why was the problem ignored?
I am sick of people claiming to be the Minister for Health and Children who deliberately leave unread any brief which gives them anything other than glory, which would mean they would have to take hard decisions to make people accountable and take responsibility. It is a problem that Fianna Fáil has in particular and the Progressive Democrats are catching it, which is that Government is about glory not about responsibility. If nursing homes are badly run, it is the Government's fault. If people in nursing homes are ripped off, it is the fault of the Government and the Minister. There is no way out of that. If people do not wish to take responsibility they should go and allow those of us who do to take responsibility. The Government parties have lost the will to take the blame or the responsibility for anything.
Hear, hear.
The Tánaiste went missing for two days on this issue. If €100 million extra were being spent on residential care for the elderly, would one expect the Minister of State, Deputy Seán Power, to be wheeled out on "Morning Ireland" on Tuesday morning to explain it? We would have the Tánaiste demanding half an hour to herself to announce the good news. When there was a difficult issue, the poor Minister of State, Deputy Seán Power, whom I like and respect, was wheeled out while the Tánaiste, who told us she is brave, went missing. That is what I call ducking responsibility. In recent months the Tánaiste told us how brave she is. This was her responsibility, as she wants the glory for it. Why is our inspection system timid, slow, late and impotent? I do not know but there are only two conclusions I can make. One points to a level of administrative incompetence that defies description and the other to a reluctance to confront the issue because of the possible implications for the public purse. If it is believed that it will cost too much to rectify the problem, thus implying we will leave old people at risk of being left to sleep all night in their own urine, then our priorities, as articulated by Government, are entirely wrong.
We were able to set up quickly a private system to inspect our guesthouses. The former Minister for Finance, Deputy McCreevy, did so in six months and removed responsibility in this regard from Bord Fáilte. There were no complex issues or problems to be addressed. Guesthouses now have to meet the standards that have been set. The new system was established in no time at all. We have a food safety authority whose representatives can walk into any restaurant at any time without notice and exercise the power to close it down if it is not cleaned up after having been deemed filthy. The authority does not have to go to court to achieve this.
I am told that reasonable levels of nursing, physical and medical care are available in a limited number of premises, which number fewer than the number of guesthouses. I am told the problem is complex. It is complex because the Government does not want to address it, for whatever reason, presumably because it is afraid it will be left with another bill. The only logical assumption I can make is that the limited money the Government believes is at its disposal would be wasted on the elderly because there would be no votes in addressing the issue. Another conclusion is that the Government is in cahoots with the owners of the nursing homes and does not want to embarrass them. I do not want to go down that road.
The second issue to be addressed in determining why circumstances are as they are is secrecy. Until 1998, health boards were allegedly inspecting nursing homes and keeping the reports secret. It was a matter of national policy that no health board would disclose the report of any inspector of any nursing home. After the enactment of the Freedom of Information Act, reports were disclosed but the Government decided to make it difficult to obtain them. There has been a dramatic drop since the Information Commissioner imposed draconian charges on those obtaining information. The health authority can say it will not publish the inspectors' reports and a considerable sum must be paid to appeal every decision.
Information, limited and bad as it was, was available and the Government decided to make it harder to obtain it. That is not its fault either. It is not its fault that it had five opportunities and ignored them. It is not its fault that it ignored the Human Rights Commission and that it wrote a script for a Minister of State that does not even address the problem. It is not its fault that people do not know what is going on.
This is not a debate about a particular nursing home but about a system under which we do not really want to enforce the law. We do not want laws that are powerful or people to take them seriously. I am becoming entirely sick of a succession of examples that are arising in this regard. On issues affecting immigrant workers, we do not do anything unless there is a complaint by people who cannot speak English. On planning enforcement, we all know how few planning enforcement orders are issued around the country. For a long time the Health and Safety Authority did not do anything until somebody was killed because it did not believe in being too rigorous. We have a list of such examples. The fundamental problem, of which the nursing home abuse is a particularly revolting symptom, is systematic indifference to making the laws of the land apply to those who are rich and powerful. This is true of most nursing home owners.
It is quite extraordinary that the body representing legitimate, good nursing home owners expressed its total frustration on the radio over the fact that it could not get the Government to take action. It wants action. Has the Government, which preaches about the need to reduce regulation, decided its ideology has carried it so far it does not want to introduce any regulation in this area? I do not know. How does one follow the logic of a Government that states it can regulate guesthouses, restaurants and Chinese takeaways at 2 a.m. but cannot regulate the places in which old people have to live? It is not a question of money or complexity but of political priorities.
The Government says the legislation is complex. I guarantee that I and my Labour Party colleagues in this House will introduce a Bill before the House rises for the summer to deal with this issue if the Government cannot do so. I will offer it to the Government and it can deal with it. The problem is not very complex; it is simply a matter or rewriting some sections of existing legislation and specifying in some detail, or giving the Minister the authority to specify in some detail, those provisions that need to be specified. The only reason the Government will not do so is because it will not remove any legislation from its legislative programme, thus implying the elderly must wait.
I agree with Senator Feeney and others that the vast majority of nursing homes are of an excellent standard. I do not know this but believe it and make an act of faith by trusting in the common decency of most of the people who run such facilities. When I go into a restaurant I do not have to depend on my belief in the common decency of the people who run it because I know there is a food safety authority with clout and the capacity to close it down. This has the wonderful effect of concentrating people's minds. We agree such regulation should apply to restaurants and, as I stated, Chinese takeaways at 2 a.m., yet we cannot find a place in a crowded legislative schedule to achieve this for our old people, even though the organisation representing most of the nursing homes asked the Government to do so and although representative after representative has called repeatedly for an inspectorate since 1984. It is 18 months since the representative organisation asked for this measure.
This issue is not solely about the Leas Cross nursing home, horrific as the abuse that took place there may be, but about why the system could be as it is. How could we have created an inspection regime under which inspectors must phone institutions to state when they will be making their inspections? One can only conclude it is a deliberate ploy to give people a chance to put their affairs in order. This is not how inspections should be carried out. Imagine what would happen if an inspector phoned a restaurant to state he would be inspecting it the following Thursday. It would be spotless. This bears no consideration at all.
There is a fundamental requirement for legislation that gives the power to set standards, inspect institutions and close them down if necessary. It should make it perfectly clear that the State has an explicit power and right to close down institutions that are not up to standard, just as it can do in respect of a restaurant or guesthouse. Such legislation is urgent and should be backed up by the necessary resources to ensure that every nursing home can be inspected frequently and without notice at various hours of the day and night. Thus, we will really know what is happening therein. When such legislation is enacted, I will not have to make acts of faith in human nature and will know what I believe to be the case, namely, that the majority of nursing homes are run by good people who care. Until we enact it, we are not only letting down old people but also those who run good nursing homes around the country.
I join other Members in welcoming the Minister of State to the House. I thank the Fine Gael group for making available its Private Members' time to deal with this issue. It is a very serious issue and not a political football. Before I left my office to come to the Chamber, I noticed many files. If I had wanted to bring the set of files on the underwhelming performance of previous Administrations, I could have done so. I did not do so, however, because I want to talk about the revelations contained in the programme on Monday night.
Perhaps this debate could focus more on ways to improve the circumstances that obtain rather than on what could have or should have been done in the past. There is collective responsibility throughout the Houses of the Oireachtas and in all parties. There are many reasons for failure but no excuses. If we could focus on conceptualising ways to improve this situation in the best possible and most efficient manner we would be better served than through playing political football, hamming on this issue or repeatedly going back over the past. However, the statistics show that this Administration and the one immediately preceding it did more for the elderly than any other Government in the history of the State. That is a fact.
The elderly are the most important section of our society. When the great history books are written at the turn of the next century, if the names of any of the political entities in these Houses are remembered it will only be because of the elderly of today and in the future. These are the people who laid the foundations that allowed the birth of a Celtic tiger or an environment where an economy such as today's could thrive.
As a result everything that can be done for the elderly should be done. If that means sacrificing services for the young and healthy in other age groups, then it should be done willingly, and to that end we should be prepared to make that sacrifice.
I watched Monday night's "Prime Time" programme. It was the first one of these investigative programmes I had seen and it was excellent. I am delighted the national broadcaster is putting its funds to such positive use, helping us to get to the root of many of the problems that still exist. It was a very good, courageous and pioneering programme. We need more of this kind of programming and I look forward to the next one and the subsequent debates in this House about the issues they bring to our attention on which we are not focusing enough time. That has to be positive. It is not political football, but politics and democracy at work in a positive way.
As Senator Feeney has said, what the programme showed was appalling. I do not believe anybody would like to stand over it. I do not want to be facetious, but I immediately thought that my 11 month old son will have to face a codicil in my will to ensure he is not going to put me into any home.
We have an aging population, with about 11.3% over the age of 65. The Central Statistics Office predicts that by 2030 that percentage will have more than doubled to 24%. A great many things must be done in terms of helping to alleviate such problems and to ensure they do not happen again. Everything possible must be done for the elderly, so they get the care they deserve and need.
Both the Minister of State and Senator Feeney alluded to the fact that most of us would like to be cared for in our own homes in old age. I like to think that is the direction in which we could go. Senator Feeney has mentioned some of the many schemes already in operation in this regard. I would like to see those further expanded, so anybody who has a condition which can be cared for at home should be provided for. The necessary financial arrangements or grant schemes should be put in place to encourage this approach. If tax incentives or other schemes are needed, these should be put in place. For those who cannot afford such arrangements there should be some waiver schemes whereby through State intervention this facility may be offered.
Obviously, everybody cannot be cared for at home. Some conditions require long-term residential care in nursing homes. I agree with much of what Senator Ryan had to say on the specific issue. Perhaps none of us could have expected that there would have been abuses as shown on television last Monday. I was shocked. I am sure that every self-respecting person was shocked that people abused their positions in the manner they did and perpetrated the types of mistreatment that were shown. It is completely unacceptable. Now that we know about it, however, there is a clear need for an independent inspectorate. We do not need one that phones in advance to say in effect, "Listen, we are going to call around tomorrow, so get the house in order." Can the House imagine if gardaí were to phone the local publican to alert him or her that they would be visiting at a particular time? That is not realistic and we cannot have that approach.
Senator Ryan referred to the Food Safety Authority of Ireland. Having worked in the food industry I am aware of an organisation called the European Food and Safety Inspection Service, EFSIS. If one is lucky enough to get a contract to supply Tesco or whatever it is an essential prerequisite to have the EFSIS standard. Its inspectors carry out audits, uninvited, whenever they want at whatever time of the day, and have access to everything. That is in private industry. It might be hard to believe, but it does happen.
We need a similar type of system for nursing homes. As many people have said, the vast majority give excellent care and stick closely to the regulations. Many relations of mine have been cared for extremely well in a host of nursing homes throughout this country. However, it is reasonable to assume that the Leas Cross nursing home is not an isolated incident and that there are others. Therefore, following on from the "Prime Time" investigative programme there needs to be an urgent review of all nursing homes in the country.
I welcome the fact that the HSE has established an independent inquiry team to investigate all areas of concern in line with the Department of Health and Children's policy document, Trust in Care. I also welcome the fact that it has put in the necessary nursing staff and made the changes at Leas Cross.
It is safe to assume, however, that this is not an isolated incident. I therefore appeal to the Minister of State to use all the resources within his good offices to carry out an investigation at all nursing homes in advance of the introduction of an inspectorate. The legislation will be very welcome when it comes and is needed as a matter of urgency. Obviously, there are realities to be addressed and the parliamentary draftsmen have to put things together in a particular manner. The Minister of State is fully committed to bringing that legislation forward as a matter of urgency and I look forward to it very much.
There is no doubt that every self-respecting citizen was appalled by what Monday night's programme revealed. I do not believe any Member of this House could have imagined the type of things that were going on in that particular nursing home and it is unacceptable. This issue should not be made into a political football, however. It is not a political issue. It is one which all self-respecting public representatives and citizens should engage in to proactively conceptualise ways in which the situation may be improved quickly, rather than people trying to score cheap political points, two years from a general election.
I agree with Senator MacSharry, but he scored a few points in his earlier remarks. However, it is a matter which should not be treated in such a manner, as one which affects the whole community. I have already spoken on the Order of Business and several times this week on this issue. A great deal of good sense has been spoken on both sides of the House, so I do not intend to use my full allocation of time. I understood there were only eight minutes, but apparently that has been extended.
It is 15 minutes.
I will not need that amount of time. However, it is important that a representative of the Independent group joins with other Members in saying that this situation must be addressed.
I beg the Cathaoirleach's pardon. I am interpreting his gestures and his sign language as asking me, in effect, whether I would like to share time with Senator Ormonde. I am grateful to him for the suggestion. Will the House permit me to share——
The Chair did not suggest that.
I thought that is what the Cathaoirleach was saying.
I was not saying that.
Is that possible?
Is that agreed? Agreed. That is 15 minutes shared between Senators Norris and Ormonde.
Perhaps the Cathaoirleach might let me know when I have spoken for half the allotted time.
I agree with those who have said this was a remarkable piece of reporting by RTE. It took a great deal of technical ingenuity using a small camera, whether in a tie pin or whatever. The visual image was very clear. The sound was also quite good. It was remarkable. That is what I call real investigative journalism. We sometimes hear people talk about investigative journalism and really what they mean is snooping into the sex lives of pop stars and so on. I do not regard that as investigative journalism, but I regard this programme as good investigative journalism because it highlighted a situation which needs to be addressed and brought it to the attention of the public and the Government.
I learned a great deal from the programme. I have had elderly relatives and connections in homes. My aunt, whom I absolutely adored, went into the Alexandra Guild House. It nearly closed but with the assistance of colleagues here I managed to put forward a programme to rescue it. Some 30 old ladies were given the stability of continuing to live there. It is a wonderful place. They do their own home baking. The staff absolutely adore their patients. It was a home in the sense of being a place where a community lived. I enjoyed going there. However, I know that people are afraid of the idea of a nursing home because they fear the sinister elements surrounding such homes. My aunt lived to the age of 103. She had very little wrong with her until, at the age of 102, she fell and broke her hip. She was transferred to a State facility. I do not want to completely blame the people there because they are under great pressure but my aunt almost immediately developed a bed sore. It was only when she got back to the Alexandra Guild House that the staff there cured it.
I believe people develop such sores because there is such pressure on the nursing profession that they are not able to do what they are required to do. Elderly people can be quite intractable sometimes. Many of the people in these homes are confused and a little contrary. The nurses should turn such patients every three hours and so on but with the pressure they are under they do not do so, and I am sure about that.
In light of my experience, I agree it is important to inspect private nursing homes because this is to where our attention has been drawn but it is unacceptable that there is no inspection of the State nursing homes and there should be. In the case of private nursing homes, inspections are supposed to be carried out twice a year but they are not.
Some time ago I raised a matter on the Adjournment brought to my attention by a person in my neighbourhood who cherished his mother who was put into St. Mary's Hospital in the Phoenix Park. Her son complained about the conditions in that hospital. I wrote a snotty letter to the director of that hospital and I got a snotty letter back and, as often happens in my life, that was the beginning of a friendship. The director said that if I was so interested in this issue, I should show some realism and come out to see the staff there. I said "What a good idea, I will". I went out and had a look and I have to say I admire the medical professionals, the nurses, the physiotherapists, the occupational therapists and so on who work in these disastrous conditions. They are absolutely awful. In one place there were leaks from a converted swimming pool. There was one lavatory for two wards. In such circumstances, how can facilities be kept clean? In those circumstances, I pity the staff as much as the patients. Some of the patients were quite happy and they were looked after as well as possible but some of them were clearly distressed.
As a friend of James Joyce, an old lady whom I knew in Zurich said to me, "David, age is a cage; it is not always attractive". One is very lucky if, like my aunt, one keeps physically well, mentally alert and emotionally balanced. Many people do not. They are confused, feel threatened and think they are not able to afford to stay in these places. They are worried about their meals and their families. I know of cases where one can visit a patient and ten minutes later receive a call in one's car — as was the case with another relative of mine — to inquire why one had not been in to see that person in a fortnight. These people are confused and difficult. They need our care as much as possible.
There are not enough inspectors and they do not have proper powers. What is the point in inspecting if there is nothing one can do? The only point of having inspectors is if they are able to impose a sanction. The two sanctions that should be available are the power to close a nursing home or the power to impose a fine. Some of these places can well afford to pay such a fine. I read in a newspaper today that Leas Cross was doing all right. It made a profit of something like €60,000 and last year it made a profit of €500,000 on foot of a grant.
I listened to a radio programme yesterday and was interested to hear a woman who rang in who was a member of the staff of that nursing home. She said she was horrified by the programme. Maybe I am gullible but I believed her. She said she was in a different unit and absolutely loved her elderly patients. She sounded sincere. It may be that even within that nursing home there are different levels of care.
I mentioned the problem of bed sores which I also mentioned the other day. I thought that developing a bed sore was inevitable after a certain age but this is not the case if a patient is turned in bed and so on. A connection of mine, a Hungarian lady, got one of these awful things and I thought it was inevitable but it was not. We need to make some further degree of investment in this area to protect people whose number we may, if we are lucky, join and we will expect our successors in this House to look after our interests.
I noticed one of the rather unpleasant nurses who was pushing his fingers into a patient's face, shouting at her and making inappropriate remarks and so on — his behaviour was not such that it could be described as criminal, it just seemed to be terribly unpleasant — but he was continually referred to as a Filipino. That is not fair because there are many wonderful, kind, gentle and good Filipino nurses. Our hospital system would be swept away without them.
It would not exist without them.
I thank Senator Norris for sharing his time with me. I am glad to have this opportunity to discuss this awful issue. I thank the Minister of State for facilitating this debate at such short notice and for listening to such an array of abuse which is most offensive.
I could nearly cry when I think back on that programme the other night. I do not want to make a political football out of this issue. I do not want Members to barrack each other across the floor of the House as to how good Members opposite would have been in dealing with this issue if they had been on this side of the House and how bad Members on this side are because we did not do the job we should have done.
We should be all singing the one tune in regard to this issue. This is a dreadful situation. All of us who saw that programme were shocked. We heard of the litany of suffering those elderly people had to endure. I was shocked and mesmerised looking at the screen when I saw a patient's bed sores, a carer putting his hand into the face of a patient and compelling her to take her tablets on another occasion, and, when an elderly lady called for attention, the carer was sleeping in a chair. That was shocking. This nursing home was run as a commercial outfit. These patients were not treated as people in the eyes of the owners of this nursing home. That shocked me all the more.
We should have had regulations in place. We are all wrong in that regard. I was a Member of this House when the Members opposite were in Government and the need to update the regulations and the nursing Act of 1990 did not arise. We all are guilty of that. The Members opposite should not give us the line that they are better than us. I am here to make sure that this will never happen again.
I thought the Senator said she did not want to make a political football out of this issue.
I hope the Members opposite are here to ensure the same.
I welcome that a director of nursing has been assigned to this nursing home and that the staff assigned to it will be upgraded. I ask that proper training be provided for carers who work in these nursing homes. If I had my way nobody would be cared for in nursing homes. I would follow the line of extending the home grants, the home help service and provide extra support for voluntary organisations. That would be my choice. I would not like to see any member of my family going into a nursing home because I do not know how many more nursing homes there are like the one that has been described. I have visited fine nursing homes and met many excellent, caring and sensitive staff there. This programme shocked me. While the Minister of State should initiate the necessary legislation, regardless of when it appears, the message is out. We have seen how people running a nursing home abused their position.
I am pleased there are such fine investigative journalists who conducted these interviews under intense pressure and worked to elderly the elderly people's point of view. We can thank the media for presenting this story, which will not happen again. We are aware of the problem and we will remedy the situation. We do not need any lectures to tell us how to do it. The Minister of State has heard the contributions made tonight and will be receptive to the points made. The Government will implement whatever measures are necessary to ensure that elderly people can live in an independent and dignified way.
I welcome the Minister of State to the House and thank him for coming at such short notice to respond to these statements. I appreciate the chance to make some points arising from the exposé aired on television on Monday last. There is no doubting the strength of the reaction among the public, the media and in both Houses of the Oireachtas.
I wish to add my voice to the expressions of shock, anger and dismay at the images of abuse of elderly people, shown on our televisions. No one should attempt to play down the disturbing nature of this issue. While we were rightly shocked at what we saw, I was not shocked at the debate on standards in nursing homes. I do not usually find it useful to rehash old statements, but on 15 April 2003 I said: "To maintain high standards of care in residential homes, an even more rigorous inspection system is essential". The wider issue of care for the elderly was debated that night.
The makers of Monday's programme will receive plaudits from all sources for the exposé but I was more shocked at being presented with the video images than at the fact that this type of abhorrent behaviour can happen. It happens across the world. When I made that statement two years ago I feared that this type of abuse was possible and probable, and may always be. That may not sound right but international surveys unfortunately show that 4% of residents in institutions are subject to abuse. I am not defending or condoning this but being honest and balanced.
In response to my contribution that day, the then Minister of State with responsibility for the elderly stated that I had, "made a number of suggestions that should be considered. These matters are under consideration". This matter is under consideration again today, in the shadow of horrific evidence.
Amid the outcry, we must look at who is responsible for what we saw on Monday night. Comments were made earlier to the effect that the Tánaiste had gone missing. The Tánaiste did not go missing. With all due respect to the Minister of State, we do not want micro-management at all times. People have responsibilities and should be allowed to speak at appropriate times. A Minister should not have to deal with every issue that arises in his or her Department.
In the first instance, responsibility for the ill-treatment of elderly citizens lies with the so-called carers in the home in question. Untrained staff were left to their own devices and the possibility of this type of unacceptable behaviour occurring is high. There may be little we in this House can do to address this directly.
Responsibility also lies with the management and owners of residential homes. When they accept patients from trusting families, they have a serious duty to ensure that residents in their care are treated to the highest standards. When the law is broken in this regard, it is imperative that there is an inspection system whereby the full rigours of that law are implemented. This is integral to deterring other unscrupulous individuals from perpetuating ill-treatment of older people.
A measure of responsibility lies with attending medical staff also. I hope that any general practitioner or nurse who tended to an older person would be able to identify any evidence of ill-treatment, and to act on that evidence through the relevant authorities. That responsibility should be supported in legislation.
It is a sad reality of modern society that families do not always treat their older members with the respect they deserve. If that is the case, families of patients must also take responsibility for allowing their loved ones reside in sometimes less than suitable conditions. I do not refer to any family of those persons depicted in Monday's programme. However, we must discuss this issue honestly and openly. Therefore, responsibility must be apportioned wherever it should lie.
Our national broadcaster has provided a public service in many ways, for many years. The programmes it continues to make are of the highest standards and have helped to bring issues to the heart of public debate and the top of political agendas. I am concerned, however, when there is any suggestion of a lack of balance in reporting.
There are many fine residential homes, public and private. Many fine staff and management run these homes. We should keep this in mind. No one can defend the behaviour revealed on Monday night. Training, standards and inspection must be looked at anew. We must do everything in our power to protect those whose capacity to protect themselves is reduced.
Responsibility for abuse of any individual lies with the abuser in the first instance, and this House has a role in making sure that the required legislation is in place to make it possible to deal with such individuals. No one should underestimate what we saw and I am not trying to play it down but we all have responsibilities. I mentioned this two years ago. Perhaps I should have mentioned it every day since. When we speak of responsibilities we must be clear about what we mean. The issue of abuse of the elderly and ageism is changing dramatically because of the way our society has evolved.
We all have much to learn and have many questions to ask. I hope the outcome of this programme will be a debate that will result in the necessary legislation being brought forward to support the Minister of State in his responsibilities and those administering nursing homes to care for the patient and the elderly and to give that the highest priority if we value society the way we should.
I wish to share time with my colleague, Senator Feighan.
Is that agreed? Agreed.
I compliment Senator Minihan on his contribution which was in marked contrast to the other contributions from that side of the House. I did not come in here to make political capital out of this scandal but given the number of footballs kicked about here this evening, one would think the debate was being held on a soccer pitch rather than in the Seanad. I was disappointed that in her contribution Senator Ormonde could not, for political reasons, pay tribute to Deputy O'Dowd who was responsible for the programme, aired on Monday night, which has unveiled a litany of abuse. It was he who conducted most of the research and was credited as having done so and he deserves all our praise. I also salute all those involved in the programme.
Senator Feeney's closing remarks were disappointing. Deputy O'Dowd has been a Member of the other House for the past three years and was a Member of this House for five years. During those eight years he has campaigned on this issue and has done more as an Opposition Member for people in nursing homes than have all the Government Deputies and Senators in a period of unprecedented economic opportunity.
I join with colleagues who have expressed the view that an independent inspector be introduced for public and private nursing homes. Senator Norris was correct in emphasising that public facilities should also be inspected and must not be excluded, although it should be pointed out that there are many involved in the nursing home structure who own and operate fine premises on which the country depends and we should not tar everyone with the same brush. However, following on from the scenes on our television screens on Monday night it is clear that urgent action in this area is needed. An appropriate inspectorate should be established and I urge the Government to ensure that the necessary legislation is introduced as soon as possible and is not allowed drag on over the next few months.
I thank the Government side of the House for providing the opportunity to hold this debate. Given that the demographic profile of the country is ageing, there is a need for the establishment of more nursing homes. For that reason I support many of the initiatives introduced by the Government such as tax incentives for those who wish to build them. It is clear there is a need for extra places, especially in view of the exorbitant rates charged by the home featured in the television programme screened on Monday night and in other homes throughout the country.
I cannot share Senator Ormonde's view on nursing homes. There are some people who, through no fault of their own or their families, have to be catered for in them. I would like to think that the day will not come when I have to go to a nursing home but who can tell the future.
That is a long way off.
It is clear that some people have to be catered for in nursing homes. Senator Ormonde's suggestion does not bear any resemblance to reality nor did many of her other suggestions.
Senator Browne raised an important issue about whether homes should be classified as hospitals or commercial enterprises. That should be addressed. The Government should have acted three years ago when the Human Rights Commission issued its report and uncovered some of what we saw on our television screens on Monday night. If I am accused of making a political football out of it, so be itbut it is my job as an Opposition spokesperson to highlight these issues inside and outside the House. The Government was negligent in not acting on the commission's report.
I thank Senator Phelan for sharing his time. Now is the time for measured words. The Government has got many things right when it comes to care of the elderly. In my local town there is a public nursing home, Plunkett Home, which it is a joy to visit. Family members live in the community. However, there are cases where the Government has not got it right. We waited a full year for a physiotherapist to be stationed in Plunkett Home in Boyle with the result that the elderly in the home were without physiotherapy for a year and a half. That was a case of negligence.
There are instances where nursing homes cannot employ somebody or where nobody wants to locate in an area full time. These situations should not be allowed to continue for such a long period. If the elderly have to go without physiotherapy for a year and a half it is systematically robbing them of their integrity and their health. While the Government has got much right in this area there are instances where it has got it wrong.
There are times when somebody should say we did not ensure the right procedures were followed. For example, what is the position of health boards? There are individuals in executive positions in the health boards who should ensure proper procedures are in place and that there are proper inspections. Will anybody in the health boards have to apologise or be sacked? No, because a cosy cartel has been created that is more important than the politicians. As politicians we can shout, as can the Tánaiste and Minister for Health and Children but these individuals know they are safe in their positions, where the benchmarking awards apply, which I welcome. However, these people must ensure they put in an honest day's work for an honest day's pay. We have created many positions of title but no responsibility. Perhaps, it is time to look at many of these positions. Clearly, the health boards need to be looked at.
Many would not be in nursing homes were it not for cutbacks in home help. Every day I, along with other politicians on both sides of the House, try to get extra home help. If home help cannot be secured the elderly have to go into a public hospital or a public or private nursing home. These are areas where we can make a difference.
As a restaurateur I find it hard to believe that while environment health officers have the powers of inspection and can close down a business if one's kitchen is a little dirty, there is no knock-on effect on some of the poor unfortunate elderly who have been systematically humiliated, as we saw in the television programme on Monday night. Sometimes the power of the media can be more important than the power of politicians. In this instance the media has instilled a sense of fear in those who want to go into a nursing home. Even those of us at a young age are beginning to ask who will look after us.
Perhaps it is time to look at the family unit. We may have become very selfish. Instead of putting our elderly parents into nursing homes we should perhaps consider looking after them at home. This situation has created a sense of anxiety and disbelief. This has been a very important lesson which should not be regarded as a political football. The Government has take some action but on this occasion it could do better.
I welcome the Minister of State, Deputy Seán Power. He is a man who calls it as he sees it which is what is required in this situation. Undoubtedly this is a litmus test for how we care for the most vulnerable, the young and the aged, in our society. Unfortunately, there have been serious failures in that regard in the specific case of Leas Cross. As was stated by Senator Feeney and endorsed by Senator Ryan and others, the majority of nursing homes are extremely well run and managed to quite a high standard, as should be the case.
The Acting Chairman will be familiar with New Ross. I was the founding chairman of the community hospital there which the Minister of State visited not so long ago. I have an insight into the process. We recruited a psychiatric nurse from a neighbouring hospital who took on the position of administrator. He turned out to be excellent. He put very good management procedures in place, recruited good staff and today, 15 years later, it is now run to a very good standard with its own hospice unit, and provides respite care and a step-down facility for the health board. The community is very proud of the hospital. The person we recruited was not in a position to find a career path within the health board system. He is now the manager of the newest major hospital in Dublin. Others were recruited internationally and failed to stay the course and he is now in charge of that hospital.
Coming from a business background I am convinced that whether it is a business operation, a hospital or the public service, one is dependent on good quality management. Unfortunately, Leas Cross did not have this and obviously did not have sufficiently caring nursing staff to attain the high standards necessary in this area.
It must be acknowledged that a systems failure existed within the Department which it would be wrong to understate. Unfortunately, this comes on the heels of other systems failures. The programme "States of Fear" dealt with historical issues within educational institutions and the Morris tribunal report highlights serious public service flaws. The time has come to examine the issue. The vast majority of public servants have made a significant contribution to all aspects of society and particularly to economic development. They should not be dragged down by a not insignificant minority who simply are not performing. I know how difficult it is to deal politically with issues such as this because politics often depends on people. I know of instances at local government level where councillors critical of the lack of performance of individuals and of the systems were subsequently boycotted by that system which refused to deal with them. This is unacceptable in a democracy and should not be allowed to continue.
In this regard I listened with interest to Senator Feighan. On the question of the introduction of benchmarking it is only right and proper that people in the public service would be appropriately paid for their responsibilities and for their performance. If there is to be a successor to the last benchmarking I hope it will be performance-based.
Hear, hear.
No system should pay people who do not perform. I know that within the public service there are people who have opted out for whatever reason, such as disappointment over not being promoted or a lack of motivation. One of the great problems in the public service is the security of jobs for life. This should not be the situation. People should be paid and their jobs should be dependent on economic issues and on continuing to perform. Many safeguards are in place to ensure this is not abused by employers in the private sector. Perhaps the time has come to do likewise in the public service.
The Lindsay tribunal dealt with the HIV scandal. Of all the tribunals and scandals in this country over the last decades, without any shadow of a doubt, this was certainly the most significant and the worst. Nobody has been held to account and nobody is in jail because of it. People cannot be insulated.
My argument was unwittingly underscored by Senator O'Toole when he referred to benchmarking as almost akin to visiting the ATM. The only difference between it and you and I visiting the ATM is the arrival of the bank statement which shows a deposit must be made subsequently to meet the money extracted. In this instance the money is coming out of the taxpayers' pockets. The system needs the introduction of some reality. We owe this to ourselves and to people within the public service who are performing exceptionally well; these people could in the private sector achieve much more enhanced economic benefit for themselves but are committed to public service.
Perhaps the time has come to establish a ministry of modernisation of the public service. One of the first places to start might be in the Department of Health and Children where some significant problems exist. I am aware that I have been critical in my comments but it needs to be said. I am glad the debate tonight has not divided along party political lines but instead the subject has been dealt with constructively. The Department has Ministers in whom I have the utmost confidence when it comes to dealing with the issues in the best interests of society, the public at large and the public service. I wish them well.
I wish to share my time with Senators Cummins and Finucane.
I welcome the opportunity to speak in this debate. I watched the programme with shock as did everybody else. It was particularly shocking because I knew one of the families involved but I never realised the experience they went through and the conditions under which their mother lived in the nursing home and subsequently died as a result of the lack of good care which she should have received there.
We have all let down those elderly people who have suffered in the Leas Cross nursing home or who are suffering in other nursing homes. We can be sure the same type of behaviour is happening in other nursing homes. I hang my head in shame at the thought that I would be responsible in any way for allowing an elderly person to be cared for in such a situation. If we cannot look after our elderly people in a proper fashion we should hang our heads in shame. These are the elderly people who worked in this country during very difficult times and the least they deserve now is to be cared for in their old age at a time when our country is doing really well and when many of us have money in our pockets. It is to all our shame that they should have been put into such a vulnerable position. It is urgent that we put measures in place to ensure this practice ceases and never happens again.
I worked in a nursing home for a short time and saw at first hand how vulnerable and totally dependent on carers many of these people are. As some of them are bedridden and may have Alzheimer's disease, they are like babies. We all know the care babies need. Many of the elderly people in our nursing homes also need that type of care. They should not be put into situations where they can be abused as we saw on television on Monday night. I agree with many of the speakers who said that many elderly people do not need to be in nursing homes. I take this opportunity to ask the Government to give people the resources to be able to stay in their own homes. They should be given additional home-help care and the disabled person's grant, and contributions should be made to voluntary organisations to allow them stay in their homes.
I compliment and commend Deputy O'Dowd for the work he has done. I also compliment RTE. It is another reflection on how we do our business here and on how the Government does its business that we need to react to programmes on television. On many occasions the "Prime Time" programme has highlighted dreadful problems in our society and we react — as we must react. However, the same issues are raised by individual Senators and Deputies in these Houses and we fail to get the responses. We raise many other issues here such as children who are in poverty and hungry without getting a response. Let us not wait for any more "Prime Time" programmes to deal with these issues. I want the issue tackled quickly to ensure our elderly people are protected.
On Monday night I was in my mother's home with my brother helping her into bed as we normally do. Although she is 88 and barely healthy enough to live independently at home, thank God she is doing so. My brother and I went into the living room and watched the television until she settled down and went to sleep. I was appalled as was everybody who saw the programme. The practices we saw during the programme were disgusting, degrading and dangerous. We would all ask whether these practices are also going on in other nursing homes. While we can all say we believe the vast majority of nursing homes are excellent, we have very little proof.
At a minimum we immediately need to establish an independent inspectorate to investigate all nursing homes on a regular basis. At present, reports are only given to the owners of premises after inspection. This practice must change so residents in such homes and their families also get a copy of the report. I hope we will urgently introduce legislation prior to the summer break. It does not require rocket science to amend the Health (Nursing Homes) Act to introduce the provisions required to assist our elderly population. These are the people who put so much into the country and helped create the Celtic tiger.
I welcome this discussion. This morning I acknowledged the role of the High Court judge who refused the owners of the Leas Cross nursing home an injunction and allowed the "Prime Time" programme to be broadcast. By doing so he has done a great service to the nation in highlighting the issue. I agree that many nursing homes are run very efficiently. A brother-in-law of mine contracted multiple sclerosis at a young age and subsequently died. He spent time in a private nursing home where I witnessed the care he was given in difficult times. It would be wrong to tarnish all nursing homes.
However, from what I have seen in the newspapers and on the television programme, this nursing home appears to be state-of-the-art and ultra modern. It was opened by the Taoiseach in 1997 and more recently an extension was opened by Deputy Wright. While clearly it is very modern, the modern veneer on the outside belied what went on inside. The programme seemed to resonate with many people on the issue of how we care for the elderly. It is on how we care for the elderly that we can be assessed. People are living longer and the Minister of State said it is internationally recognised that only 5% of the older population will need long-term care in private nursing homes. Modern buildings are being constructed in many cases with tax incentives. I wonder whether the sense of caring and the social dimension in those private nursing homes is being acknowledged or whether the bottom line is of paramount importance.
In my area in the mid-western region, few patients receive subventions from the Health Service Executive to go into private nursing homes, so most patients are private patients. However, in this case approximately 80% of the residents were public patients.
I was interested in what Senator Jim Walsh said earlier about the Health Service Executive and I wonder what research the executive does before placing people in such homes. There is pressure for step-down facilities owing to the problems in hospitals who do not have places for elderly patients. However, a hospital should not resolve a problem it has without being satisfied about the step-down facilities available. This is why it is critical to have an independent inspectorate. If we go into the summer recess without doing something constructive in this area we would deserve to be castigated by the people. Traditionally when we go into summer recess the attitude of journalists is,"They're off". However, we should be ashamed of ourselves if we do not move amendments to the existing legislation, if that is what is required, and fail to put a framework in place. The Minister of State has said he is to have a meeting with the committee, which is to report in the middle of June. I have tried to be constructive in this discussion. One could be very critical of some of the things happening, having listened to Senator Minihan detail what happened in 2003. I wonder whether the then Minister of State, Deputy Callely, was listening at all at the time. This is something that has not suddenly materialised. We should have known it was imminent. If there were problems in the past, they were highlighted.
We should sit up and take notice. If there is one message for the future, it is that we should not need a "Prime Time" programme to take action regarding such situations. If one is running a health service effectively, especially with the new Health Service Executive, one should take timely remedial action. We should not need that type of programme to highlight this issue. We should be thankful that it was on, but in future, we should not be reacting to "bushfires" in the Health Service Executive and trying to extinguish them.
I welcome the opportunity to reply to the debate in which most Members have been constructive. They might have got off to a bad start——
Did the Minister of State think so?
——but those speakers who came afterwards made amends. Reference was made to the Tánaiste, and some criticism was expressed about her not getting involved in it. I was given responsibility for services for older people, and I cannot see anything wrong with the Tánaiste allowing me to deal with the issue.
It was brought to my attention towards the end of last week that it was intended to show this programme. I did not see it until Monday night, like everyone else, and on foot of that we decided to take action. My biggest concern, having seen it, was to ensure that the other residents should get some comfort, giving them the option of moving. That is what we decided. Earlier we had sought to take charge of the nursing home, but that was not possible until yesterday. We have put in place an agreement whereby we will run the nursing home. I have asked the HSE to give me a report on all its dealings with the home. I hope to have that within a day or two and to receive a report after a month to see how the new scheme is operating.
Senator Norris always provides some food for thought in his contributions, and today was no different. He mentioned the necessity, when bringing about change, that inspectors have powers to impose sanctions. Most Members referred to that in their contributions, although perhaps not in the same way. However, I feel there is general agreement in the area. Yesterday the Taoiseach gave a commitment in the Dáil that we will be introducing an independent inspectorate. That will be put in place early in the autumn. We are reviewing the Health (Nursing Homes) Act 1990 and the Nursing Homes (Subvention) Regulations 1993. It is clear from having watched the programme last Monday that there are several gaps in the legislation and regulations must be tightened regarding training and staff requirements. We will focus on those areas to bring about the necessary changes. I do not claim we are more compassionate, understanding or more caring in Fianna Fáil than those in the Labour Party or Fine Gael. We would all have been surprised at what we saw that evening.
Horrified.
There is a certain understanding and realisation that there is an issue regarding elder abuse, the vast majority of which, unfortunately, takes place in people's own homes. We are aware that the issue exists, but it came as a terrible surprise to people to see the type of abuse that went on in that home. We must be honest and say that, while there are gaps in the legislation, if people want to abuse old people, it is impossible for us to prevent it. If they are bad enough and want to do it, no matter what legislation is in place, they will do it. When I saw that person I wondered, if they did that to an older person in the company of a third party, what he might do when alone.
It is obvious that the inspectorate we had in place was not working. We will give the new inspectorate the powers to deal with such situations. We will put that in place in the autumn. In the meantime, I will meet regularly with the HSE, and I hope it will devote more resources to that area until such time as the independent inspectorate is put in place.
I thank Members once again for their contributions. In fairness to nursing homes, from our experience of visiting family and friends in them, we would have a different view and experience from what we saw on Monday night. The vast majority of nursing home staff would themselves have been disgusted that a nursing home should cast such a cloud over others throughout the country. I know it is their wish and desire that we make the necessary changes to legislation and regulations to ensure it is easier to identify which homes are providing the high standards we all require and that the older people of the country deserve.
Perhaps I might thank Senator Brian Hayes, the Leader of the Opposition, who proposed at 10.30 a.m. this morning, at very short notice, that we substitute this motion for the Fine Gael motion. Second, I thank the Minister of State. It is very rare that one secures the attendance of a Minister of State so quickly. His private secretary and office showed great readiness when our office contacted them.
We thank the Minister of State for attending so speedily. We appreciate it.
When is it proposed to sit again?
At 10.30 a.m. tomorrow.