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Seanad Éireann debate -
Friday, 23 Mar 2007

Vol. 186 No. 15

Health Bill 2006: Second Stage.

Question proposed: "That the Bill be now read a Second Time."

The Health Bill 2006 is a central element of the Government's reform programme for the health service, as well as meeting commitments made in Quality and Fairness — A Health System for You and Towards 2016. The measures proposed in the Bill, in particular the establishment of the Health Information and Quality Authority and the Office of the Chief Inspector of Social Services, will bring about a safer health and social services system which will entrench quality at all levels and in all settings.

The Bill was framed with the central purpose of creating a new standards-based approach to health care services. Patient safety and quality of services are the key principles underpinning the arrangements set out in it. In many respects, the Bill represents a new and radical departure for the health system and the changes it introduces are fundamental to delivering a better health system in Ireland.

The Bill will create a national body, the Health Information and Quality Authority, often referred to as HIQA. The purpose of the authority is to set quality standards and secure compliance with those standards in an open and transparent way. In line with the national health information strategy, the new body will also have a vital role in developing, evaluating and improving the gathering and use of health care information. It will also ensure emerging health care technologies are independently and objectively assessed to benefit both patients and taxpayers.

The functions of the authority will be to set standards of safety and quality for all services provided by the HSE and service providers on behalf of the HSE, as well as private nursing homes, with the exception of mental health services which are covered by the Mental Health Commission and the Inspector of Mental Health. It will monitor compliance with the standards it sets and advise the Minister and the HSE on the level of compliance. It will undertake, on its own initiative or at the request of the Minister, investigations into the safety, quality and standards of services where it believes there is a serious risk to the health or welfare of a person receiving services. It will carry out reviews to ensure best outcomes and value for money for the resources available to the HSE and operate accreditation programmes for health and personal social services in both the private and public health sectors. It will also carry out assessments of health technologies, including drugs and medical devices and perform a range of information related functions with regard to health services and the health and welfare of the population, including evaluating existing health information, identifying deficiencies, advising the Minister and the HSE on those deficiencies, setting information standards and advising the Minister and the HSE on compliance with those standards.

The Bill also establishes the Office of the Chief Inspector of Social Services as an office within the authority with specific statutory functions. The chief inspector will be an employee of HIQA with independent statutory functions which include the Social Services Inspectorate's current inspection work, namely, conducting inspections into children's residential services run by the HSE, as well as the important new functions of registering and inspecting residential services for those with disabilities and older people, including private nursing homes.

In line with guidelines on regulatory impact assessment, a public consultation process on the legislative proposals was undertaken last year. More than 70 submissions were received and the proposals to establish HIQA and the Office of the Chief Inspector of Social Services were generally welcomed. The key features of the Bill reflect the outcome of these consultations and I am confident the Bill was strengthened as a result. Discussions took place with the interim HIQA board and the social services inspectorate on the Bill. Much preparatory work has been carried out by the interim HIQA board to ensure it can use its statutory powers as quickly as possible.

The Bill honours a commitment made by the Minister for Health and Children last year to provide for protected disclosures, more commonly known as whistleblowing, in the health service. It does this by inserting a new part into the Health Act 2004 covering a range of circumstances. The effect will be to create a structure within which protected disclosures can be properly made and investigated and to provide appropriate protection for the persons making such disclosures in good faith and in accordance with the provisions of the legislation.

I now turn to how the system of standards, registration and inspection for all designated centres will work together to create a fully independent and robust registration and inspection system. These centres will be inspected against standards set by HIQA and regulations made by the Minister. The chief inspector will have extensive powers to carry out inspections and may enter a centre, examine any records, take copies of documents, inspect and remove other relevant items and interview residents and staff in private. I should make clear that the registration and inspection requirements will apply to Health Service Executive residential centres, centres operated by agencies funded by the HSE and private nursing homes. This will guarantee that the public, voluntary and private sectors providing residential services will be required to meet the same standards of care. The chief inspector will also be responsible for overseeing the Health Service Executive's performance in complying with regulations and standards in foster care for children, pre-school services and what is called in law the "boarding out" of older people where they reside in someone's home. Residential centres covered by the Bill may not operate unless they have been registered by the chief inspector and it will be an offence to operate without registration. A centre must be in compliance with the conditions of its registration. Registration details will be available to the public on the Internet. The chief inspector can cancel a registration if the residential centre fails to meet standards.

Where necessary, the Bill provides for action to be taken quickly to protect service users. This includes provisions for the urgent deregistration of centres where the chief inspector, on application to the District Court, believes there is a risk to the life, or a serious risk to the health or welfare, of people resident in a centre. Accordingly, issues will no longer arise about the legal capacity to deal with failing nursing homes or residential care centres. If necessary, they can be closed down.

Senators are aware that the Minister for Health and Children established a commission on patient safety and quality assurance to examine and make recommendations on a system of licensing for all public and private providers of health care. This will include public, private and voluntary hospitals. We have general agreement that this is the direction we must take to give patients the greatest possible assurances of safe and quality care. The Minister asked the commission to report to her within 18 months of its establishment last December. The commission established a subgroup on licensing which may be in a position to come forward with recommendations in advance of the commission's report. The subgroup proposes to invite private health care providers to consult it as part of the process. The commission also plans to advertise for submissions on the various areas it will address as part of its work.

Part 1 of the Bill, comprising sections 1 to 5, inclusive, contains standard provisions dealing with the Short Title, interpretation, commencement, establishment day and expenses. Part 2, sections 6 to 12, inclusive, makes provision for the establishment of HIQA, details its functions which I outlined and contains provisions required for its operation and other matters. In line with arrangements for other statutory agencies responsible for setting standards and monitoring compliance, section 10 provides that standards set by HIQA must be approved by the Minister. Section 11 provides that the standards will be admissible as evidence in court proceedings, while section 12 allows the authority to require information from the HSE and service providers. Under the regulations, the Minister will be able to set out the procedures to be adopted by the authority in setting standards. This is to ensure the appropriate statutory bodies will be consulted before standards are drawn up.

Part 3, comprising sections 13 to 20, inclusive, provides for the establishment of the HIQA board and related matters. The board will have 12 members. Part 4, comprising sections 21 to 25, inclusive, covers standard provisions dealing with the appointment of the chief executive officer. Part 5, comprising sections 26 to 28, inclusive, contains standard provisions dealing with the recruitment of employees and advisers.

Part 6, comprising sections 29 to 39, inclusive, deals with the accountability and funding of the authority. It includes provisions allowing the Minister to give HIQA general directions to ensure ministerial policy will be clear. It contains provisions requiring the authority to draft codes of governance and a five-year corporate plan for ministerial approval. It also allows HIQA to charge, should it deem it appropriate, for any services it provides, except those it provides for the Government, the HSE or public service providers. There is also provision for the Minister to determine the authority's net annual expenditure and a requirement for the authority to submit a business plan to the Minister on an annual basis.

Part 7, comprising sections 40 to 45, inclusive, deals with the Office of the Chief Inspector of Social Services. Section 43 provides for the appointment of inspectors to staff the inspectorate. I should mention at this stage that section 72 allows HIQA, at the request of the chief inspector, to appoint qualified persons to assist the chief inspector and inspectors in the inspection of residential centres. Section 44 deals with the corporate and business plans for the office of the chief inspector and their inclusion in HIQA's corporate and business plans.

Currently, the HSE carries out inspections of voluntary children's residential centres and private nursing homes. The legislation provides that these will become a statutory function of the chief inspector. Section 45 provides that the Minister may require the HSE to carry out such inspections on behalf of the chief inspector. This is intended as a temporary arrangement to facilitate the continued inspection of these facilities pending a transfer of staff and resources to the authority. Such inspections must be carried out in the manner specified by the chief inspector and in accordance with standards set by HIQA and regulations made by the Minister.

Part 8, comprising sections 46 to 69, inclusive, deals with the registration of designated centres. Under section 46, a person shall not carry on or manage a designated centre unless it is registered and the person is the registered provider. A person is prohibited from managing a designated centre if the centre is not registered. Under section 47, any person applying for registration or renewal of registration is prohibited from giving misleading or false information. Sections 48 and 49 deal with requirements in regard to applications for registration and the details to be included by the chief inspector in the registers he or she maintains. The registration of a designated centre is for three years.

Section 50 provides for the granting or refusing of applications for registration. The chief inspector will grant the application if satisfied that the registered provider and any other person involved in the management of the centre is a fit person and the centre complies with standards set by HIQA and regulations made by the Minister. If the chief inspector is not satisfied on these counts, the application will be refused and conditions may be attached to registration.

Under section 51, the chief inspector can cancel a registration, vary a condition of registration or impose new conditions in certain circumstances. These circumstances are where the registered provider or other person involved in the management of the centre is convicted of particular offences or is not a fit person, or where the centre is not meeting its regulatory requirements. Under section 52, registered providers may apply to the chief inspector to vary a condition of registration.

Sections 53 and 54 provide for notification by the chief inspector of proposed decisions and the right to respond. The chief inspector must give notification of proposed decisions to refuse or cancel registration, vary or attach conditions of registration or impose new conditions. Time is allowed for the making of written representations. Section 55 provides that when the decision is made by the chief inspector, the person is informed in writing of the decision.

Section 56 sets out certain requirements and prohibitions in regard to designated centres, while section 57 provides for the right of appeal, on the part of a registered provider or applicant, against a decision by the chief inspector to the District Court. Appeals must be brought within 28 days after receipt of a written notice from the chief inspector. Section 58 provides that the chief inspector can apply to the District Court for an order enforcing certain decisions.

The Bill provides for the urgent cancellation or varying of conditions of registration where the chief inspector believes there is a serious risk to the health or welfare of residents. Sections 59 to 61, inclusive, set out the procedures and arrangements in this regard. The chief inspector must apply to the District Court for an order in regard to the registration and this application may be made ex parte and without notice to the registered provider. An ex parte interim order may be granted by the court if it considers it necessary or expedient to make the order immediately in the best interests of the residents. The chief inspector may apply to the court for a final determination. Notice of this application must be given to the person who was the registered provider at the time of the ex parte application. Under section 62, the Bill provides for the appeal of District Court decisions to the Circuit Court, while section 63 provides for the chief inspector to be a party to any court proceedings under this part of the Bill.

Under section 64, the chief inspector must notify the HSE immediately when registration is cancelled and the executive must make alternative arrangements for residents. Section 65 requires a registered provider to furnish the chief inspector with such information as he or she may require. Sections 66 to 68, inclusive, are technical provisions dealing with the closure of designated centres and the appointment of persons by law to take charge of a centre. Section 69 sets out the transitional arrangements for existing designated centres to allow them to operate pending registration for a period of not more than three years.

Part 9 deals primarily with investigations by HIQA and inspections by it for the purposes of monitoring compliance with standards set. It also deals with inspections of designated centres by the chief inspector. Section 70 allows HIQA to appoint persons known as "authorised persons" to monitor compliance with standards set and carry out investigations where the Minister believes there is a serious risk to the health or welfare of a person receiving services. Section 71 provides that the HSE may appoint persons to examine designated centres operated by service providers for certain purposes. For example, this may be to establish whether centres are complying with the terms of any funding given to them by the executive.

Sections 72 to 77, inclusive, deal with the right of entry for authorised persons to relevant premises owned or controlled by the HSE or service providers. This deals with the inspection and taking of copies of relevant documents and contains standard provisions that apply to procedures of this type. The chief inspector, in respect of inspections of designated centres, has precisely the same powers as authorised persons. In addition, under this Part, a warrant may be obtained from the District Court if an authorised person or the chief inspector, where appropriate, is prevented from entering premises or believes there is a likelihood of being prevented from entering premises. In these circumstances, an authorised person or the chief inspector may be accompanied by a member of the Garda Síochána. It will be an offence to refuse, obstruct or give false or misleading information to an authorised person or the chief inspector. Provision is also made for entry to a private residence, if necessary. Section 78 provides for qualified privilege for the reports of the chief inspector or authorised persons.

Part 10, comprising sections 79 and 80, provides for the offences under the Bill and the proceedings for summary prosecutions. A person guilty of a summary offence is liable to a fine of up to €5,000, a term of imprisonment of up to 12 months or both. A person guilty of an indictable offence is liable to a fine of up to €70,000, a term of imprisonment of up to two years or both.

Part 11, comprising sections 81 to 85, inclusive, contains the standard provisions for board members, employees and advisers on standards of integrity, codes of conduct and prohibition against unauthorised disclosure of information and the standard disqualifications from board membership and employment.

Part 12, comprising sections 86 to 97, inclusive, provides for the dissolution of the Irish Health Services Accreditation Board and the interim Health Information and Quality Authority and the transfer of their employees to HIQA. Part 13, comprising sections 98 to 102, inclusive, provides for the general power to make regulations and specific powers to make regulations regarding registration arrangements and standards in designated centres. Under section 8, regulations may also be made on the procedures to be followed by HIQA in setting standards.

Part 14 amends the Health Act 2004 by inserting into that statute a provision dealing with protected disclosures in the health service. This is an important innovation and it is important it should be featured in the Bill which is essentially about standards for patient care and safety. The concept of a protected disclosure, as set out in the Bill, is framed on the basis that the disclosures are made in good faith and on reasonable grounds. The type of disclosure that will attract protection includes disclosures about actions that put the health or welfare of those in receipt of services or the public generally at risk. Employees making protected disclosures will be required to follow set procedures, established by the HSE or their employers, except, for example, where urgency is a consideration. If the person making a protected disclosure is an employee, it safeguards him or her from workplace victimisation. Furthermore, any person making such a disclosure will have immunity from civil liability, except where he or she recklessly communicates an opinion or makes a false, misleading, frivolous or vexatious allegation or gives information which he or she knows to be incorrect. It should be noted that if a person makes a report that is false or misleading, he or she may be prosecuted for committing an offence under this Part.

There are detailed redress procedures involving access to the rights commissioner service and, on appeal, the Labour Court for employees who believe they have been victimised for making disclosures. The terms "employee" and "employer" have been specifically adapted to cover any entity which provides a health service inside or outside the remit of the health legislation. Employees in private sector health facilities will also be covered by the protections in this Part where they report a matter to a professional regulatory body. Any person who reports to a professional regulatory body will be covered by the protected disclosure provisions.

Part 15, comprising sections 104 and 105, provides for consequential amendments to other legislation. Schedule 1 deals with the repeals and revocations of relevant orders, while Schedule 2 sets out the precise amendments to other legislation. One of these amendments is to the Civil Registration Act 2004 and arises from the urgent need to continue to facilitate the marriage of seriously or terminally ill people who, by reason of their illness, are unable to travel to a public venue for their marriage.

I know Senators will agree experience shows that the case for a standards-based approach is indisputable. There is an imperative for change and a new approach based on high threshold standards that are rigorously monitored and consistently enforced. By establishing and empowering robust and independent structures in HIQA and the Office of the Chief Inspector, this Bill will help ensure the necessary change happens. I commend the Bill to the House and look forward to hearing the views of Senators.

I welcome the Minister of State and his officials to the House, but I cannot welcome the Bill, which is regarded by this side as a belated response to the criminal and systematic abuse of senior citizens in need of continuous care. While I welcome the establishment of an inspectorate of residential services for older people, people with disabilities and children in care, the Bill is flawed and does not meet the standards set out in my party's policies. The Government could have gone much further in this legislation, but has failed to do so.

According to the Government, this Health Bill addresses patient protection, but it does not put the patient at the centre of health services. How could we possibly support it? After the recent disastrous failures in the health service, such as the scandal at Leas Cross, the MRSA crisis, deficiencies in hospital hygiene and people left waiting on trolleys in accident and emergency departments, patient protection should be our number one priority, but that is not the case in this legislation.

People have had hospital procedures cancelled more than once and, as a result, have been condemned to die by the failures of the health system. Elsewhere, a post mortem ascertained severe burns sustained from a radiator while in the care of a nursing home in County Kilkenny. These issues in the health care system should be corrected by the Minister for Health and Children and addressed by the legislation.

At Leas Cross, the HSE allowed elderly people to live in neglect and danger. That is where this legislation originated. Every day in accident and emergency departments, people are left waiting in Third World conditions. When patients leave such departments for wards, their lives are continually threatened by the Government's failure to deal with matters of hygiene, MRSA and all the bugs found in our hospitals each week.

Nothing in this legislation deals with the MRSA scourge. It is strange that, as MRSA has grown more prevalent in our health care system, other European countries have addressed the issue, in some cases successfully, while all we get is the same old bluster and bylines to the effect that the Minister is interested in patient safety, when that is not the case. For this reason, the legislation fails. If this legislation had been in place for the Leas Cross matter, I wonder whether the person who complained would have been ostracised by the HSE.

The only way to protect patients is to establish a patient safety authority with full responsibility in this area, as Fine Gael and the Labour Party proposed. People would trust such an independent body to inquire into their complaints. Even if there is a failure to establish an independent patient safety authority, one would at least expect the Minister to regard Members of the Oireachtas as suitable authorising persons on condition that they make inquiries in a discreet manner through the appropriate Minister. Members do not abuse parliamentary privilege and they respect the institution of the Oireachtas.

The Bill does not recognise or protect patients residing in centres registered by the Mental Health Commission or patients residing in acute hospitals. We need strong legislation to protect the vulnerable people who must use one of our health care institutions. The Social Services Inspectorate and the commission should have been amalgamated as part of a patient safety authority. It is vital that we do not stigmatise those with mental illness as being different from patients in the rest of the health service. Instead of breaking down barriers and destigmatising certain sectors, the Government is drawing in an even darker pen the line between patients with mental illness and patients in other areas of the health service.

There is a crisis concerning children, particularly refugee children, who were trafficked into this country and escaped the protection of the HSE. For example, the Minister is well aware that children went missing from a child care facility in Dublin. We have no idea where they have gone or what happened. Such an institution is not covered by this legislation. It covers nursing homes and other specific institutions that have made media headlines rather than those to whom protection should be offered.

Those suffering mental illness will remain stigmatised because the Government sees fit to protect mental health patients under a different body. The commission is good and I wish to apply its principles to the entire health service. We should not continue to marginalise and stigmatise people with mental health difficulties.

The Bill proposes too many distinct roles for HIQA, which take from the original and sole purpose of the legislation. The immediate role relates to the setting and monitoring of standards of residential care. Subsequent roles for HIQA relate to the evaluation of information concerning the health and welfare of the population and setting information standards to ensure best outcomes for resources available to the HSE. The scope of HIQA's role is too broad in its current form.

One of the problems with HIQA is that patient safety is not its core objective. The role of the inspectorate is to examine standards in all institutions involved in health provision. HIQA's role does not just concern social services inspection, but also the evaluation of technologies. This is a nice euphemism that slipped through in the explanatory memorandum. Another of HIQA's functions resembles that of the National Institute for Health and Clinical Excellence in the United Kingdom.

Patients in other countries have been given power in that they are placed at the centre of their respective heath services. Too much confusion is evident within the processes and systems here. It is unnecessary for the Minister to make all of the changes she has proposed. The establishment of a patient safety authority would give power to patients. Once the Minister moves the power base in the health service more towards patients, the changes she is having difficulty getting through will follow automatically.

I hope the Minister of State will take on board some of the facts we have highlighted. HIQA is not a patient safety protection agency, its remit is too broad and it will not work. The Minister must separate the inspectorate and combine it with the commission to set up a proper patient safety authority. Perhaps the Minister should not dismiss what the Fine Gael and Labour parties are doing, given that the WHO believes it is correct.

Ba mhaith liom fáilte a chur roimh an Aire Stáit. I welcome the Bill and the opportunity to speak on it, as it is an example of how the Minister is forging ahead with necessary change.

As we all know, this Bill is a fundamental part of the health reform programme begun by the former Minister for Health and Children, Deputy Martin, in 2003 and continued by the current Minister, Deputy Harney, since taking over the Department of Health and Children. The programme is the most extensive reform of the health system in more than 30 years and its priority focus is improved patient care, better value for taxpayers' money and improved health care management.

The development of a world class public health service is a core objective for everyone in the House because we want to expand quality and access. We will achieve this through greater investment and system reform. No one can claim there has not been investment in our health services during the past ten years. As a share of national income, non-capital public expenditure on health has increased from 5.8% of GNP in 1997 to 7.6% today. The Government is matching this increase with reform. For example, the HSE has been established under the reform programme. While I acknowledge it is facing many challenges, I am confident it will succeed.

The Bill has many important components, one of which relates to the protection of whistleblowers. We are all familiar with cases which came to light when whistleblowers draw attention to them. Those who came forward to expose the details of the Neary case can take credit for bringing to light the outrageous practices in that instance.

The Minister for Health and Children, the Ministers of State at the Department of Health and Children and the Members of the Dáil and Seanad are responsible for introducing legislation. They are not responsible for operational matters. It seems Opposition Senators like to infer that the Minister is to blame if there is malpractice in a hospital, or if a hospital is not living up to the standards of care and cleanliness one would expect. As somebody who worked in a hospital for many years, I remind the House that those who are paid as managers have to manage. If management means taking harsh decisions against subordinate staff who are not doing their jobs properly, clear decisions have to be taken on whether the people concerned should continue to work in their current roles.

The Bill will establish the Health Information and Quality Authority which will guarantee information and assure a certain quality of service and put in place an inspectorate and all that pertains thereto. Patients will benefit from the top class service that will be secured by the authority. The inspectorate will ensure the standards of care which will obtain in care locations will adhere to best practice. One of the key policy aims of the health reform programme is to deliver high quality services, based on best practice supported by evidence.

My colleague on the other side of the House, Senator Coghlan, spoke about the use of trolleys in hospitals. We have to be fair and admit that the number of patients on trolleys has reduced significantly. Similarly, there has been a substantial decrease in the number on waiting lists. The phrase "A Lot Done — More To Do" is as true today as it was the day it was first coined. The nature of the health service means there will always be more to do.

The establishment in this legislation of the Health Information and Quality Authority is a central part of the Government's health strategy. The authority's mandate is to ensure standards of world class apply to health and personal social services throughout the public, private and voluntary sectors. The authority will engage in monitoring and inspection to ensure those standards are upheld. It will provide information on health and personal social services and undertake health technology assessments.

All the information available should be given to those caring for others. This is important to ensure carers can offer the best possible health care service. The Health Information and Quality Authority will play a crucial role in providing the highest quality and most efficient health services for patients. The authority will bring a common thread of efficiency, quality and effectiveness to the health sector. It will inform and assist decision-making at national, local and individual level. It will ensure best practice is advanced nationwide rapidly, effectively and consistently. It will act as a resource for planners, health care professionals, patients and their carers by helping them to make decisions about treatment and health care.

The Health Information and Quality Authority will provide a stamp of assurance by acting as an underwriter for taxpayers. It will ensure the highest possible standards of safety and systems are adopted by and embedded within the sector. It will guarantee value for money in the delivery of health and personal social services. A great deal has been said about the waste of money. The establishment of the authority and the inspectorate in this legislation proves that the Government is keen to obtain value for money in the health sector.

A great deal of the Bill's focus comes from the fact that the Health Information and Quality Authority will incorporate a new and independent inspectorate and registration authority for residential services. The independence of the inspectorate will be one of the central reasons for its success. It will not have to look over its shoulder at Members of the Oireachtas; it will be able to do whatever needs to be done to discharge its functions without apologising to anybody. The establishment of the inspectorate will allow us to get tough in setting and enforcing standards. One should not doubt that an independent organisation with real power is being created.

The Bill will place the existing Social Services Inspectorate, SSI, on a statutory basis. It will provide for the expansion of the SSI to allow it to inspect and register residential services for people with disabilities and older persons. This will ensure there will be no recurrence of the problems at Leas Cross and other nursing homes, which have been exposed in recent years. We cannot undo what has been done. We can never change history, but we can learn its lessons.

The Social Services Inspectorate was established in 1999, on an administrative basis, to inspect social services. While it initially prioritised the inspection of children's residential services run by the Department, it has recently extended that remit to cover foster care services. Such inspections are particularly important in the light of the revelations of recent years about the abuse of children in some care centres. The SSI bases its inspections on the national standards for children's residential centres, the 2002 standards for special care units and the 2003 standards for foster care. These standards which were produced by the Department of Health and Children were the first nationally agreed standards in this area.

It would be remiss of me to mention foster care without commenting on the important service foster parents provide for children and parents who experience various difficulties. I wish to state publicly that I appreciate the fantastic role played in society by foster parents.

The inspection reports of the Social Services Inspectorate include findings and recommendations based on the standards of best practice. The first full round of inspections of statutory children's residential centres was completed in 2005. The SSI uses the unique insights it gains through inspections to support developments which improve quality in the sectors in which it operates. Its annual reports give an overview of its findings in the sector, prioritise areas for improvement and offer a national summary of service provision.

The Social Services Inspectorate will be established as an office within the Health Information and Quality Authority, thereby allowing it to continue its work on child welfare and protection services. The current inspection and registration arrangements are being replaced and strengthened. There will be a fully independent inspectorate for public and private nursing homes, as well as for the first time centres for children and people with disabilities. I welcome this provision, one of the most innovative aspects of the Bill.

This legislation provides for clearer procedures which will allow a centre to be closed if its continued operation poses a risk to the health or welfare of its residents. It outlines an explicit procedure to be followed if a centre needs to be closed immediately or urgently. The Government is responsible for ensuring the standards set are applied consistently and on a national basis. We need to outline the circumstances in which action can be taken quickly and effectively, when necessary, to protect service users.

The Health Information and Quality Authority will have strong powers to monitor standards, including the power to enter and inspect premises, access documents and interview staff. Senators will be aware of a notorious case in the last couple of years in which documents disappeared. The Bill will give the inspectorate more power to deal with such cases. The authority will engage in reviews and inspections to ensure standards are being met. It will investigate serious concerns relating to health or social services. It will evaluate and provide information for staff and the public on how well services are performing. Such information will inform the planning of future services. The authority will also assess new and existing drugs and equipment to ensure that they impact positively on the quality of life for patients and, importantly, represent value for money.

Inspections by the chief inspector of social services will be carried out against standards set by HIQA and ministerial regulations. They will cover areas such as accommodation, qualifications, numbers of employees, food and records. In regard to the number of employees, in some cases, especially in private nursing homes, the euro features largely on the horizon, particularly in geriatric care, where a certain staffing level is required to meet the needs of patients. It will be a core role of the inspectorate to ensure that all care locations, public or private, will have the required number of people to provide the appropriate service. That is important.

If the chief inspector is not satisfied that a residential centre meets the relevant standards, the centre will not be registered and will not be able to operate. If he or she considers that a registered centre fails at some stage to comply with standards, the registration will be cancelled. In other words, if such a centre does not deliver, it will be shut down and rightly so.

The Minister of State outlined the penalties and I will not repeat them. The HIQA is already established on an interim basis and it will be established on a statutory basis under this Bill. It has undertaken a considerable amount of work to ensure that it will be able to recruit staff and undertake its responsibilities following the passage of this legislation.

We all have a right to expect that when we or our loved ones come into contact with our health and social services we will be treated safely with high quality care, dignity and respect. The responsibility for delivering a quality service lies with the providers of health and personal social services. I am sure that HIQA will be a strong and fair watchdog to protect those in residential care settings. I welcome the Bill and wish it a speedy passage through this House.

I welcome the Minister of State to the House and I also welcome the Bill. We were all dismayed by the report written by Professor Des O'Neill on the conditions in certain private nursing home. It became clear that we needed far more robust standards for the inspection of institutions which provide cared for people, including children, who are elderly, ill or vulnerable. This is a welcome and rapid response to the problems that were disclosed.

The Bill is wide-ranging. The provision for the scope of premises to be reviewed and certified by the inspector and his or her staff is enormous. It will take a great deal of work, even with inspections only every three years, to ensure they are all properly covered. The bill for such inspections will be an expensive one for the Minister for Finance.

I did not agree with Senator Glynn when he said it is our role only to introduce legislation and following that we have no responsibility. I was much more taken by what Senator Mansergh said on the Order of Business this morning when we discussed the issue of the State's responsibility to children in our national schools and the fact that the State, the Government and the Department have no responsibility for children who might be abused in our national schools. Senator Mansergh pointed out that legal and moral responsibility are different. I would have thought we all have a huge responsibility to ensure that this Bill is implemented and the recommendations in it are enforced.

It is easy to introduce legislation and we are terrific at writing reports but subsequently there is frequently very little action. I would like to be assured that plenty of money will be available to the inspector and to his or her staff to ensure that what we wish to achieve with the enactment of this legislation will be implemented. That is extremely important. Most people in these institutions are vulnerable. Some have relations who visit them frequently. However, Senator Glynn has often pointed out that some patients in psychiatric institutions, a service in which he had a career before he became a Member of the Seanad, have visitors very infrequently. Effectively, many of them are on their own and rely on the staff and those who should implement regulations to make sure that they are safe, comfortable, not bullied and so forth. We have a continuing interest in this legislation.

Operational details are a matter for employees and not for the Minister of the day or Members of this House. People who are paid to do a job in an institution or a hospital should do it and not depend on the Minister.

I thank the Senator for that information but the Minister is at the top of the tree. If the authority is not doing its job, it is the Minister who is supposed to keep an eye on the authority.

The health care providers in private nursing homes will be covered by this legislation. The explanatory memorandum states:

The Authority will operate accreditation programmes and other schemes aimed at ensuring safety and quality in the provision of services. It will also be open to private health care providers to apply to the Authority for accreditation.

I am not sure who are these private health care providers. The Minister of State, when replying, might indicate who they are. The more people who are accredited under this scheme the better.

The authority will be required to bring forward a business plan. Business plans are great but the preparation of them by an institution can be terribly time-consuming. I hope this requirement does not take up too much of the authority's time. Business plans can vary, on occasion, by the hour. The legislation allows for the plan, when brought forward, to vary but I would not like to think it is one of the most important tasks the authority will undertake.

Will a logo or some other symbol be introduced that private nursing homes or residential care facilities could display? That would encourage people to obtain accreditation and meet required standards. Owners of premises, such as restaurants or shops, usually have a sense of pride and can point to a logo which shows they meet certain standards. Will certificates have to be publicly displayed in a residential unit? I did not note a reference to such a provision in the Bill.

I am glad the section on protected disclosures has been brought forward because whistleblowers want to be anonymous. We would not have had the Neary inquiry if two midwives had not gone anonymously to the then North Eastern Health Board to voice their complaints. To the great relief of myself and everybody else, the Northern Eastern Health Board management acted rapidly. What followed from that showed dangerous practice was taking place. Whistleblowing legislation was badly needed and it appears that the provision in that respect is well covered.

The Minister of State mentioned the Commission on Patient Safety and Quality Assurance which it is hoped will report by the end of 2008. If it makes any recommendations that the Minister considers would be useful to this legislation, I hope this legislation would be amended. Will the Minister encourage the amendment of this legislation so that the advice of the commission can be taken on board? There is not much point in setting up a commission on this issue if we do not act on its advice if it appears sensible.

I was pleased to see provisions in the legislation for the functions of the authority but I would prefer if they had been explained more fully. I refer to subsection 8(1)(h) which states, “ to evaluate the clinical and cost effectiveness of health technologies including drugs and provide advice arising out of the evaluation to the Minister and the Executive;”. I have stated both in the House and at the Joint Committee on Health and Children on many occasions that the only people undertaking assessment of health technologies are those in the drugs industry. They are most unlikely to declare that a hot bath would be better than taking some anti-arthritic drug or painkiller. It is essential that the Government ensures other technologies are considered and I would welcome this. I question whether there will be co-operation with the Health Research Board on this matter as it is a mighty undertaking for the authority. The setting up of such trials would be a significant undertaking. Does the legislation provide for the authority to do this on its own or with the help of the Health Research Board?

I remind the Minister of State that the drug companies carry out all the research in these areas. Even at international level it is rare for trials to be carried out on other treatments in concurrence with drug therapy trials. Independent hospitals will sometimes carry out such trials. For example, in the case of slipped discs, one third of patients will be given operative treatment, another third will be given drug treatment and the final third will not be given any treatment. In many of these trials, all patients turned out the same after a couple of years. This is not to say some patients did not have more pain than others. These trials are well worthwhile but they are not apparent in this legislation.

Subsection 8(1)(i) states, “to evaluate available information respecting the services and the health and welfare of the population;”. This is a public health issue of significance. Will there be any co-operation with public health doctors or will the authority have a solo function? We need to know how these two subsections will operate. Will the authority do the work itself or farm it out to other institutions?

I welcome the Bill which will have a speedy passage through the Houses of the Oireachtas. I hope it is enacted in the near future.

I welcome the Minister of State to the House. I have an interest in speaking in this debate because of my document on a new approach to ageing and ageism.

The establishment of the Health Information and Quality Authority comes not before its time. I am in favour of its powers to establish, monitor and investigate standards of service provided by the HSE or on behalf of the HSE. I can only hope the authority will be rigorous in both the setting of standards of service to be provided and in its monitoring of these in practice. These standards are in place to help protect the most vulnerable in society.

The Seanad has debated on many occasions the standards of care afforded to nursing home residents since the Leas Cross scandal broke in 2005. In February 2007, Professor Des O'Neill, the author of the Leas Cross report, spoke about a new study which revealed that almost 90% of residents in nursing homes have a disability. He declared that our nursing homes are populated by the most frail group of older people.

This Bill provides a framework for serious action to be taken and I sincerely hope that real action and improvements take place. The Office of the Chief Inspector of Social Services, which is also established in this Bill, will ensure a fully independent inspectorate for all nursing homes, both public and private, as well as for centres for children and those people with disabilities.

We have a special obligation to all those in care such as young people, children, older people and those with disabilities. On too many occasions we have witnessed an abominable neglect of the duty of care. Let future generations not speak of our treatment of those in residential care in the same tones we have used to speak of those in positions of authority in years gone by.

We must ensure they do not ask, as we have done, "How could they have let that happen? Why did no one stand up and shout stop?". We are now learning about the mistakes of the past but it is truly lamentable that we had to be shamed into action by a television programme. It is my hope that investigations into safety, quality and standard of service carried out under the auspices of the Health Information and Quality Authority will be initiated promptly and conducted thoroughly.

We in Ireland are fantastic at introducing regulations and in drawing up reports but, for God's sake, I ask that these regulations dealing with nursing homes be implemented and enforced. It is not enough to pass this Bill; we want to see enforcement. I cite the examples of countries like Germany or Switzerland where laws are introduced, implemented and enforced.

We all know that talk is cheap and that actions speak louder than words. Regulations which are not enforced are not worth the paper they are written on. What good is a system of two inspections a year, either announced or unannounced, when the findings are obscured by bureaucracy or a lack of resources or will and a fear of implementing them?

The northern area health board received numerous reports of the deficiencies in Leas Cross but nothing substantive was done until outrage at the "Prime Time" television programme brought it onto the public radar. That must never happen again.

It is vital the response to suspicions of ill-treatment of those in residential care takes place with the least possible delay. If residents of designated centres find themselves poorly treated they may often have nowhere else to go or nowhere that is capable of meeting their needs. We cannot allow them to languish in suffering.

I am pleased the chief inspector will have the power to act quickly in urgent situations. Leas Cross was a wake-up call to those responsible for these matters. We must ensure they stay awake, alert and on the job. I run a food production company and I know the implementation of standards by the multiples is impeccable. Visitations by the retailers to the food production companies are both announced and unannounced. There is no excuse. People will be required to deliver and to have the highest possible standards. We need the HSE and the bureaucracy to implement and enforce these decisions.

I welcome the Minister of State and his officials to the House. I also welcome the publication and the passing by the Dáil of the Health Bill 2006. This is important legislation because it is timely and necessary. Many of the points made by Senator White are correct as far as the implementation of the Bill is concerned.

The benefit of this Bill is that inspections will be carried out not only on private nursing homes but also on public nursing homes. They were exempt from the original inspection system that was carried out by the former health boards and which continued under the Health Service Executive. One gets the impression there was no inspector operating, but in fact there was. From my experience on the health board, quite a number of private nursing homes came under very close scrutiny. The possibility was raised that some of them might be closed down for poor conditions. However, in many cases the service, care and kindness provided by many owners and managers of these institutions was second to none. There may have been difficulties with the facilities, but the care and attention was not lacking. The public nursing homes were exempt from any inspection whatever by this inspectorate, which was an anomaly because many of the public nursing homes had conditions which were not up to the standards we expect in this millennium. That is why I welcome the fact the Bill provides for the inspection of public nursing homes.

The residents in public and private nursing homes are not empowered when it comes to their views on the management of these homes. There is a case to be made for a committee within the institution to be consulted on issues and to voice concerns. Many of the active residents of nursing homes are quite capable of putting forward the views of other residents on care and conditions. When I visit the Sacred Heart Hospital in Roscommon, I meet patients who have brought to my attention on behalf of other patients the conditions of sanitary facilities in those institutions. There is a case to be made for the empowerment of those patients.

A tax incentive is provided for the establishment of nursing homes, but there is no control on the numbers we require. In fact, some quality nursing homes are surviving and possibly making a good profit, while the demand does not exist for other nursing homes in the same locality. In that respect, there is excessive competition and because it is tax driven, there is no control. The inspectors and the Health Information and Quality Authority should be given some power to license the establishment of nursing homes in a specific area in advance of the construction of the home. They should also have a role in the plans for the home. There is no reason the plans for a nursing home should not be submitted to the authority for its views on the design of the building. I am also pleased there is an attempt to utilise the staff currently employed.

I discovered something in the Bill which I thought was being removed from all legislation. Section 13(3) states:

A person is not eligible for appointment as a member of the Board or a committee of the Board, if the person is-

(a) a member of either House of the Oireachtas or of the European Parliament——

Senator Dardis wishes to make a change to the Order of Business.

Debate adjourned.