Private Members’ Business.

Nursing Homes: Motion.

Dr. Twomey

I move:

"That Dáil Éireann,

concerned at:

—the absence of an independent statutorily-based inspection regime for all nursing homes;

—the lack of information and transparency about standards applying to nursing homes;

and

—the failure to make current inspectors' reports easily accessible and available to the public, nursing home residents and their families;

calls on the Government to:

—immediately establish an independent nursing homes inspectorate for all nursing homes (public, private and voluntary);

—publish all inspection reports and make them available to residents of nursing homes and their families and to make them available and accessible to the public, free of charge, and on the Internet;

—fully resource the nursing homes inspectorate with appropriate professionals such as doctors, nurses, pharmacists, geriatricians, other relevant health personnel and building inspectors;

—introduce uniform assessment criteria for all nursing homes; and

—immediately introduce a national strategy on elder abuse."

I would like to share time with Deputies O'Dowd, Pat Breen and Perry.

This is a very important debate which does not arise solely from the "Prime Time Investigates" programme last night. This is an ongoing issue that has created considerable concern for a number of people for the last number of years. Much of what has occurred in this area and much of the lack of concern about what is happening here has occurred in the life span of this Government. This is why we expect the Government to give clear answers about why it has failed so badly to look after older people.

Only 5% of the elderly population will end up living in nursing homes so it is vital there are regulations and legislation in place to protect this very vulnerable group from abuse of the kind reported on "Prime Time Investigates".

The Government has done very little to combat elder abuse in nursing homes. The National Council on Ageing and Older People submitted a report on elder abuse to the Government in 1998. A working group was set up which did not report back to the Government until November 2002. The former Minister of State at the Department of Health and Children, Deputy Callely, this self-styled champion of the elderly, said on publication of the report that:

up to recent times, there was a feeling that elderly abuse didn't exist in this country but I can assure you that, as a politician who keeps in very close contact with his constituents, I was aware that there was a problem out there, the extent and nature of which needed to be identified. I will be immediately seeking to have this report formally accepted by Government and I am determined to press ahead with its implementation, starting the year 2003.

Nothing has been done in that length of time. The former Minister of State was merely following in the footsteps of his colleagues in Government because it is not just since 1998 that this Government has chosen to ignore this issue.

One very important aspect of this issue is the Government's commitment to the social services inspectorate, an independent group that can inspect nursing homes. This differs from the current arrangement whereby owners of nursing homes are given prior notice of inspections with very little follow up. What we are discussing has arisen from this regime. The Government gave a commitment to establish the social services inspectorate in the national health strategy, in An Agreed Programme for Government in June 2002 and Sustaining Progress between 2003 and 2005. Yet nothing has been done to protect extremely vulnerable patients in nursing homes. That is the basis of this debate.

What happens when a nursing home is inspected? It is quite clear that there are limited guidelines about what a nursing home inspector can do and a lack of uniformity around the country in the reinforcements of these same standards of care. Tonight's debate revolves around private nursing homes. I will let other speakers focus more on private nursing homes. Only a small percentage of private nursing homes provide poor standards of care for their residents. The vast majority of nursing homes, both private and public, show great respect in their care of the elderly. However, we have let down a small minority of patients, who in some respects are being tortured in nursing homes, by having very unclear regulations.

Does the Minister of State know how many public institutions across the country house their residents on the third, fourth and top floors of buildings? Many of these patients are bedridden or immobile and would not be able to escape if a fire broke out. We have witnessed such tragedies in other countries. Patients are still being tied to chairs. I am sure the Minister of State is aware of Buxton chairs. Patients are put into these chairs, are tilted backwards and are left in them all day so they cannot be a nuisance to staff. There are many other issues about which the Minister of State has done nothing. It is a disgrace and I hope the other speakers will highlight these issues.

During the deliberations on the Travers report, civil servants were brought in to explain what went wrong with the illegal nursing home charges. An issue that was raised at that time was that despite an amendment made to the Health (Nursing Homes) Act 1990 in 2001 which gave the Minister power to make regulations governing standards requiring convalescent homes to have adequate medical, nursing and paramedical staff and facilities consistent with their patient profiles, no new regulations governing standards of care in nursing homes have been introduced since 1993. We have had reports, commitments, promises about legislation and the introduction of amendments, but nothing has been done.

I am sure members of the Government would like to see if there is anything positive they can talk about with regards to this issue. The only positive thing they can focus on is that the Government has committed approximately €2.5 million to fighting elder abuse in the last three years. However, this figure has been committed right across the community services and hospital services sectors. On the basis of these recommendations, the Government promised to spend €13.5 million but spent only €2.5 million on elder abuse. There has been total and utter neglect in the care of the elderly and this, especially the abuse of elderly patients, is a disgrace on the Government. We are discussing a small minority of private nursing homes that have been allowed to get away with this. In some respects, they have been allowed to get away with murder.

Earlier today on Leaders' Questions we discussed the case of a very elderly lady who was admitted to hospital. The medical registrar at the hospital said the lady had massive necrotic ulcers in her buttocks, was dehydrated and had sepsis, in other words blood poisoning from infected wounds as a result of being totally neglected in a nursing home. It was the same former Minister of State at the Department of Health and Children, Deputy Callely, who sought to make representation on behalf of this patient. Luckily, this woman wound up in an acute hospital and survived the massive necrotic ulcers in her heels and buttocks. When the Minister of State, Deputy Callely, received the report did he say this must never again happen under his watch? He did exactly what he apparently did with illegal nursing home charges. He probably whispered it in somebody's ear and left it at that. This issue was far too serious.

We have neglected the care of the elderly, particularly elder abuse in many of our institutions. I am very interested in hearing what the Minister of State has to say about this issue. I do not think people could believe this type of abuse was occurring until they saw it on "Prime Time Investigates" last night. Those of us who have been involved in medical services know that all is not well.

I hope the Minister gives a clear commitment and not the type of commitment we have seen since 1998, with promises of reports, working groups and legislation that is basically useless. If we cannot close down these places, the least we can do is regulate them properly. Many of them were built on the basis of tax concessions for people who needed some place to put their money. They are not motivated to look after elderly patients but to cut their tax bill. Throughout the country we see what is going wrong. People who are not really interested are being put into this sector and this is the result.

Serious and enforceable regulations are the responsibility of the Government, and it cannot wriggle its way out of this issue. It tried to wriggle out of the illegal nursing home charges and is trying to wriggle out of this problem. It must introduce regulations and a care of the elderly policy for the future. It must stop stalling, as it is doing.

Mr. O’Dowd

This is about public service by a public service broadcaster, RTE. The "Prime Time" programme last night was wonderful. It was well researched, well thought out and well produced. It showed RTE at its best in terms of exposing what is bad. I commend it on its work. This debate is the result of that work. I wish to put on record my appreciation of the work of the Sunday Independent, particularly Jody Corcoran, who has always published information I receive about nursing homes throughout the country.

This debate is not foreign to the Minister of State or his predecessors. There was a debate on this in 2001 in the Seanad when I raised with the then Minister the case of a nursing home in County Louth. It was the first one to come to my attention. I got a complaint that a lady was freezing in her nursing home. I went there with her husband and we found the lady in bed, fully clothed and freezing. The home was freezing, with a temperature of 12°C. It was a cold day. The temperature in the home ought to have been at 19° to 21°C. Old people die if they do not have adequate heating but there are nursing homes such as this. The Minister knew that in 2001 but there was no change in nursing home legislation. The system continued as it was and it continues like that today.

Today, the Taoiseach offered the same pious platitudes as the former Minister for Health and Children, Deputy Martin, the former Minister of State Moffatt, and their predecessors. They are aware of what is going on but they do not care about what happens. The Tánaiste made a song and dance about care of the elderly, but where is she tonight? Why is she not present? She ought to be here. This has generated the greatest amount of public concern in recent years about care of the elderly, but no member of the Government is present. That is what the Government does — nothing.

This is the Government that changed the Freedom of Information Act and made it more difficult to find out what is happening in our society. It increased the charges for freedom of information requests. In response to a freedom of information question I asked recently about a nursing home, I was informed by the health board that under a section of the Freedom of Information Act it could not give me the information. The reason was that it would bring the health board to a halt. I rang up the person concerned and asked what was the problem. He said: "The problem is very simple, I have 1,000 pages here and you expect me to go through every one of them and take out the names of all the people concerned, but I cannot do it and we do not have the resources to do it."

That is the Health Service Executive we have, and it is not good enough. I complained bitterly about that. I left a message with a gentleman who appeared tonight on the RTE news, Mr. Aidan Browne. He is a senior executive in the HSE with responsibility for nursing homes. When I called him I was told he was not available. I responded that he sends me letters but does not sign them. I asked where he was and was told he was at meetings or travelling. I left my name and asked that he ring me, but a week later he had not rang. He can appear on RTE but he cannot ring a Deputy to discuss the issues. That is what the Minister is presiding over and it is neither acceptable nor good enough.

There are 423 nursing homes in this country. The vast majority of them are excellent institutions but a significant minority of 33 were given adverse reports last year. They were bad nursing homes providing unacceptable care. In some instances, the care was appalling. What has the Minister done about it? What did the Minister, Deputy Callely, do about it when he was told about it in a letter from Beaumont Hospital? The letter was from a consultant in Beaumont Hospital who was speaking about the worst pressure sores he had ever seen. He wrote the letter in 2004 but the incident occurred in 2001. In the second last paragraph of the letter he said he could still vividly remember how bad the sores were.

What is happening in our nursing homes? There is another case involving a man in a certain nursing home. There are other nursing homes in the county concerned so I will not mention it although the press has the story anyway. The man died in the nursing home. The health report states that he was in a cold, darkened room. He had nobody with him and had no facility to call anybody should he need assistance. It took me four long years to get those facts. Why was that? It was due to the Freedom of Information Act, appeals and lack of staff in the Information Commissioner's office. I have numerous examples of and reports on bad nursing homes in this country. I am sick of it, as are the people. They want change. Will they get it tonight from the Minister of State, Deputy Tim O'Malley, the Taoiseach, the Minister for Health and Children or the Government backbenchers?

We have reached a terrible stage. I will draw a comparison for the Minister. When I was a teacher, I and my pupils researched the workhouse in Drogheda in 1843. We examined the minute book and the students wrote down information from it which they then reproduced in a lovely little book. RTE covered this at the time. In 1843, people were extremely poor and when they had nowhere to go they went to the workhouse. Under the workhouse system, there were poor law guardians who held public meetings. At the first meeting they held in public, they were fighting about the beige cloth, who should sit in the big chair and so forth. Nevertheless, the guardians had matron's reports and the press reported on their meetings. One can discover from the press reports — I looked at the reports — what was happening in those workhouses. The public knew what was happening.

What do we know now? The Government has put the nursing home sector and the entire health service in the hands of a bureaucracy that cannot be questioned or held to account in this House. Its personnel will not respond when one telephones. If one asks a parliamentary question, one will wait three months for a reply — I had to wait that length for a reply to a question about a nursing home and I am sure my colleagues in the House have had similar experiences.

The Government has betrayed the people's trust. It has removed the health boards but has put nothing in their place. Aidan Browne would have rang me when he was an executive in the North Eastern Health Board — I met him every week — but he did not ring me on this occasion because he is not accountable to me or to this House. The Government takes no responsibility for what it has done but it stands indicted for delivering the health services into this appalling mess. I accuse all members of the Government of not doing their job and not caring. The mumbled speeches are not good enough. The people want more, they want action.

The Taoiseach said today that he will change the law, and I welcome that. On the Order of Business I asked him if the nursing homes reports would be available outside of the Freedom of Information Act. The Ceann Comhairle ruled that the question was out of order. The issue is that the Freedom of Information Act is the only way to obtain nursing home reports; there is no other way to access them. Up to December 2004, if the nursing home objected it could take up to four years to get the full facts. The Information Commissioner made a recent decision in this regard, and she is on the record as stating that such reports should normally be available. However, they are not normally available. Moreover, the Government introduced a measure with the result that if one wants to appeal the refusal of the health board, a €75 fee must be paid. That may be fine for Members of the House but it is not for Mrs. Murphy, Mrs. Maguire, John Malone or anybody else. The Government is protecting the bureaucracy through the changes it made to the law in regard to FOI. It stands condemned for that.

The Minister of State, Deputy Callely, knew about the case referred to in the letter from the consultant. He was the Minister with responsibility for the elderly — that was his job. While he made good representations, what changes to the law did he bring about as Minister? The answer is none. The Government shies away from its responsibilities; its members do not resign. The Minister of State, Deputy Callely, ought to resign. He knew everything about the most appalling case of bedsores the consultant involved had ever experienced.

What should we do? Many people have family members in nursing homes. After all the publicity, they wonder whether their wives, husbands, sons and daughters are in good nursing homes. How they can find out this information? If a family member is in an acute hospital, the hospital staff will probably suggest the family member should go to a nursing home in the area. Therefore, the HSE is sending people to nursing homes its inspectors say are not good enough or about which it has had adverse reports. Will the Government take responsibility for this? While most nursing homes are excellent institutions, how does one discover this information?

An example may illustrate my point. If one searches for information on nursing homes on the Internet, one can examine information on nursing homes in the United States and the legislation governing them. Two minutes after leaving the Chamber, one could access information on Chicago, Illinois, and find how many nursing homes are within the city's bounds; one would find that there are 56 nursing homes in the area. It is possible to access individual nursing home sites. One of the nursing homes is named Waterford, so, needless to say, I looked at its site. The reports on individual nursing homes detail the number of patients in the nursing home, the staff to resident ratio, the degree of dependency, the proportionality between high dependence and low dependence, and the state and national averages in this regard. It is possible to make a judgment on each nursing home. If a nursing home is not doing its job and the inspectors are unhappy, it is fined on the spot. If a nursing home is not run properly, it will be fined anything from $5,000 to $100,000, or the inspection regime will put in its own people to run the nursing home.

That is what happens in the United States. I am critical of American norms and standards with regard to many parts of the world but with regard to nursing homes, they cannot be beaten. However, one cannot find out about nursing homes in Ireland. That is a shame on the Government. It has long known how bad some nursing homes are but has done nothing about it.

One of the ladies featured on last night's television programme was laughed and jeered at by a nursing home attendant, who pushed himself on her and behaved in an appalling, rude way. She told him: "Go away from me. You are rotten." That is what I say to the Minister: the Government is rotten in this context. It knew about the situation but did nothing. People up and down the country are saying the situation is not good enough and not acceptable, and they will not put up with it any longer. At the least, the Minister of State, Deputy Callely, should resign. The truth will come out on all of these issues, although it is a very sad and unacceptable truth. We have a big job to do.

The amendment to the motion is laughable and cynical. It suggests the Government will do everything when it has done nothing. The Government should be humbled. It should admit it was wrong and did not do its job. Yet, it will now try to cod us again.

We have complaints about nursing homes containing 1,000 pages of names while people are lying without due care and help. A nursing home I know of had 30 residents but only seven fish to feed them. How did it intend to divide that fish? There are nursing homes with hungry and terrified residents. These cases are all on the record. The Minister should ask the HSE about them. The Government claims it will send gardaí to investigate the nursing home referred to in last night's programme. Why does the Government not publish all the reports it has? Why does it not demand the HSE answer to it?

The Dáil is taking off next week because there is a bank holiday on Monday and it is proposed to rise in early July. The Labour Party leader proposed earlier that we should sit for another week to bring in the relevant law. We should do so. We want this situation to change. This side of the House is offering the Government the leadership it so sadly lacks. We will facilitate change in every possible way because it must and will happen.

There is little else I can say on the issue. I thank my colleagues on this side of the House who supported me on the motion, in particular, Deputy Twomey. The Minister cannot afford to let this opportunity pass; it must be seized. I do not know the contents of the speech the Minister of State, Deputy Tim O'Malley, will deliver, although I have a copy of it. Its contents are similar to what the Minister said in 2001. I do not have a copy of the speech the Minister made last year when Deputy Olivia Mitchell and I raised this issue, but I am sure its contents are also similar.

Things must change; the people demand it. Old people in that nursing home, and other homes about which we know, have endured pain, suffering, hunger and torture. However, their suffering, appalling and awful as it is, may bring about change. Some good may come of their awful pain. However, the change needs to happen now. There must be an end to all of this.

Mr. P. Breen

I commend Deputy O'Dowd for his emotional contribution. He has obviously put much time and research into this important subject, which has been highlighted by the Fine Gael motion.

Like most of my colleagues, I recognise that excellent nursing homes exist, providing excellent care, and that many occupants are happy with that care and their surroundings. However, I compliment the makers of last night's "Prime Time" programme for their efforts in highlighting the issue.

It is sad that the Taoiseach takes a narrow view of the problems highlighted in the Dáil today. Instead of surmising it would be fair to conclude that some other nursing homes have similar problems, he preferred to suggest the problem at Leas Cross is an isolated one. A critical situation exists and people's lives are at risk. The Taoiseach said that nursing home staff have a responsibility to highlight care issues and I hope he is considering legislation to protect whistleblowers. Does he think staff will be thanked by management for highlighting issues of neglect?

I have visited many private nursing homes in County Clare and the shortage of beds makes it difficult for patients to get into nursing homes for a short or long-term stay. As a result many patients had nowhere to go this winter which put huge pressure on health services throughout the county. There is an urgent need for more private nursing homes in a properly protected environment. However, there is also a need for more long-stay beds and their closure is a disgrace. Some 147 public long-stay beds have been closed in the west since 1997, forcing elderly people into nursing homes and their families to pay huge sums of money for care.

In my constituency of County Clare the minimum legal standard of two inspections per year was met and the eight nursing homes were inspected twice last year. In the remaining area of the former Mid-Western Health Board, north Tipperary's 13 nursing homes were also inspected twice. In the Minister of State's area of Limerick, 18 of the 20 nursing homes were inspected twice and the remaining two were inspected three times or more during that period. Those two nursing homes received adverse reports.

The key problem highlighted in last night's "Prime Time" was that ultimate sanction does not apply. The law does not allow for nursing homes to be closed for repeated offences. If it did, the Health Service Executive would not have alternative facilities to house the occupants. I am not suggesting that the nursing homes in Limerick deserve ultimate sanction. However, such sanction does not exist.

The figures also highlight that the number of inspections is too low. Last night's programme indicated the laughable fact that nursing homes may not be aware of the inspections in advance. Inspections should dramatically increase when a nursing home receives adverse reports. If the home cannot be closed it should at least be subject to unannounced weekly, even daily, inspections if required. Some might call this harassment, but it is better than the harassment experienced by ill-treated and vulnerable people who have spent the best part of their years building up this State to what it is today. The Government claims responsibility for the Celtic tiger but the foundations of our success were laid by hard-working people, many of whom are now in nursing homes. They paid high taxes on low wages and should be allowed to enjoy their twilight years.

The Taoiseach has given assurances on new powers of social services inspectors based on the legislation being drafted. The situation calls for urgent review. Deputy O'Dowd has been calling for such a review of this legislation in recent years to allow for absolute sanctions, the closure of nursing homes, the transfer of occupants, the independence of the inspectorate and the resources required to protect nursing staff should they expose neglect.

The Minister of State, Deputy Tim O'Malley, has just left the House and has been replaced by the Minister of State, Deputy Sean Power. He should, in his contribution this evening, indicate that some measure will be put in place to protect these people who paid high taxes throughout their lives. They are at a vulnerable age and must be protected.

I commend Deputies Twomey and O'Dowd for putting forward this timely motion. We must take action now and it is up to the Minister of State to improve the situation.

Mr. Perry

I compliment Deputy O'Dowd. I am glad the Minister of State is present because the State's conduct towards older people is totally appalling and negligent. The whole country experienced shock, disgust and revulsion at the content of last night's "Prime Time". It has once again highlighted how the State has failed our most vulnerable. This is a repeat of the nursing home charges scandal, when senior Government figures knew about legal charging of patients in contract beds for the past four years and ignored the fact that the Bill was fundamentally changed in 2001.

Quality of life for those living in nursing homes is totally dependent on the nature and standard of care they receive. From my experience in Sligo, all the institutions are exceptional and staff take to their calling with care and affection, whether working in private or public nursing homes. Having visited caring institutions throughout Sligo and Leitrim, what was evident on our television screens last night was in no way the practice in those counties.

We must make provisions against those who will not abide by common decency and who treat those they are supposed to be looking after with disrespect. It is shameful that the Government was aware of the problem, yet did nothing. It ignored the problem. The level of State funding for those in private residential care has not increased in 15 years. Subvention is €190 per week, yet the rate of private charges has quadrupled.

A framework of quality in long-term residential care for older people in Ireland was published in 2000. Its stated objectives were to maintain our elderly in dignity and independence in their own homes, restore the elderly who become ill or dependent to independence at home and encourage and support the care of the elderly in their own community by family, neighbours and voluntary bodies in every possible way. If our elderly cannot be maintained in dignity and independence at home, we must provide a high quality of hospital and residential care. This is where the State has failed dismally.

Another report was issued in 2002 by the working group on elderly abuse, entitled Protecting Our Future. It is critical that people who built our future are treated in such a manner. It is 2005 and the Government has not acted. It has spent millions on reports on the elderly but nothing has been done. The Government has failed the medical, nursing and all care professions by allowing a small number to damage the reputation of many good people who carry out fantastic work.

The amount of money spent by families on the provision of services is extraordinary. Other providers are obliged to obtain quality marks, such as ISO 9000, the IQA award and hotel accreditation awards. The provision of care services is very demanding and can cost up to €1,000 per week, but there is no regulation. Where is the political accountability? Will this scandal produce another Michael Kelly? Will another secretary general have to present his or her head on a plate as in the case of illegal nursing home charges? The former Minister, Deputy Martin, did not accept political accountability, but the current Minister must do so.

Where is the initiative from the Minister? Long-term residential care is a critical part of care services and should be treated as such. It should be provided to a standard so that residents experience health and social gain from the services. What do people in the 80s feel about going into long-term care? They are hugely concerned. Attention must be focused on quality and effectiveness of long-term care services rather than on the provision of such services to a minimum standard, as is happening. For a small number of people it is about minimum standards and high profit, which is utterly appalling.

Change and regulation is needed but we do not have either at this time. There should be movement on the part of the Department of Health and Children. The Government has failed the caring profession by not introducing regulation. The vast majority of the caring profession are totally innocent but could be regarded in the same light as those shown in last night's documentary. There is no statement of policy, uniformity of standards, independent inspector or mechanism of quality assurance. Public health carers have been let down.

This Government should be ashamed of its lack of movement in respect of care of the aged who are the most vulnerable in society. It has failed on the illegal charges issue and it has failed on this issue. We must introduce regulations to promote quality assurances in all private, voluntary and Health Service Executive long-stay facilities.

The Department of Health and Children gave no leadership or political accountability on this issue. I heard the Minister of State on radio this morning. He cannot pass the buck on this issue. He is the person in charge and he should insist that regulations be introduced forthwith. We do not need to spend €1 million on introducing a report that will be shelved like the five reports going back to 1998 on the care of the aged. It is a disgrace.

Minister of State at the Department of Health and Children (Mr. S. Power)

Eight months ago I was appointed to this job and I am prepared to take full responsibility for it.

Mr. Perry

That is good news. I am glad to hear it.

Mr. S. Power

I move amendment No. 1:

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

"—notes the Government's commitment to ensuring that high quality care is made available to all patients in public, private and voluntary nursing homes;

—welcomes its commitment to establish the Social Services Inspectorate on a statutory basis later this year and extend its work to public and private nursing homes;

—welcomes the urgent review by the Department of Health and Children of the operation of the Nursing Homes Act 1990 and the Nursing Home Regulations 1993 to strengthen the powers available to the Health Service Executive (HSE);

—welcomes the HSE's provision of information to the general public on nursing homes;

—welcomes the proposed implementation by the HSE of a common national approach to the inspection of nursing homes;

—acknowledges the work of the HSE in developing responses to the issue of elder abuse;

—commends its policy of supporting older people in their homes and communities in keeping with their stated wishes, and providing support to those who need residential care; and

—acknowledges the significant investment made by the Government in the care of older people at €1,068 million in 2005."

We have taken the necessary action and I will outline that action to the House.

I welcome the opportunity to address the House on this important and very emotive issue. I was extremely concerned by the findings of the "Prime Time" programme last night. It is unacceptable that older people should be subjected to the type of environment portrayed by 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 following is the agreement arrived at earlier today. First, the Health Service Executive northern area will assign 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. Second, a clinical governance steering committee will be established. This will be multi-disciplinary and will involve a representative of the residents, their families and an independent expert. The steering committee will oversee implementation of all recommendations. Third, an independent inquiry team will be established to investigate all areas of concern. Fourth, the HSE northern area will explore all options regarding the future management of the home.

Policy is to maintain older people in dignity and independence in their own homes, and in accordance with their wishes, for as long as possible and to provide a high quality of long-term residential care for older people when this is no longer possible.

It should be remembered that it is internationally recognised that only 5% of the older population will need long-term care. However, people are generally living longer lives these days and even though most are leading healthy independent lives, the number of people in need of long-term care is increasing. There is huge demand on public long-stay places, and these days there is a growing reliance on using private nursing home places.

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, Quality and Fairness — A Health System for You, to extend the remit 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 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.

In addition, the Department of Health and Children is urgently reviewing the operation of the 1990 Nursing Homes Act and the Nursing Home Regulations 1993 to strengthen the powers available to the Health Service Executive. This will be wide-ranging with the rights of the patient as the centre of its work. It will update the Nursing Homes Act and regulations so that any issues in respect of employment law, training of staff etc. are reflected in the new legislation. I intend to have this Bill published this year to allow an early debate with all stakeholders on a new framework for all patients in nursing homes.

In regard to information, I regard this as one of the most critical issues to be covered by the Bill. In this day and age it is unsatisfactory for people not to have comprehensive information easily available on services being provided in nursing homes. I will ensure that the new Bill will include a specific provision for easy access by the public to inspectors' reports on nursing homes; I understand that is not possible under the current legislation.

I am aware that the HSE will develop as a matter of priority a common national approach to the inspection of nursing homes. This work will be facilitated by the fact that the HSE, as a national agency, can more easily implement a common policy than the previous situation where we had ten health boards and the Eastern Regional Health Authority. The work can be a useful prelude to the establishment of the social services inspectorate on a statutory basis and the application of common standards of inspection.

The Government's commitment to the development of a comprehensive range of services for older people can be demonstrated clearly by outlining the resources made available in recent years for service developments. Since 1997 to 2005 inclusive, additional spending on health care services is in excess of €302 million.

In 2004, a total of €9.5 million in additional revenue funding was allocated to services for older people and for 2005, this figure is being increased to €15.228 million. This funding will be used for a variety of services including the nursing home subvention scheme, home care grants, the home help service, the 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 in the community. Older people who are being discharged from the acute hospital system and those living in the community are being targeted under these schemes.

In the eastern region people have been discharged from acute hospitals under the Slán Abhaile and Home First pilot projects. These projects have recently been evaluated and the reports of these evaluations will be available shortly.

The Department has been working with the HSE to develop a national home care grant scheme. A draft of the scheme is currently being finalised by the HSE. Funding of €2 million has been allocated to the HSE in 2005 to introduce the scheme.

When vulnerable older people have an issue with the service and the contract of care provided to them, it should be safe to expect that there are clear structures in place for them to complain. However, it should also be clear that any complaint would not prejudice the complainant. I note that notices of complaint should be made in writing to the general manager of the local community care area of the Health Service Executive.

In recent years there have been great strides in developing supports for older people who feel defenceless. The HSE advised that the Senior Help Line — 1850 440 444 — was established with the support of the health boards in 1998 and since 1999 has received in excess of 10,000 calls from lonely older people nationwide. The service is confidential and non-directive and is available throughout the State for the price of a local call.

The HSE indicated that there are now approximately 300 volunteers working from nine centres across the country — all older people who have gone through a rigorous training provided in conjunction with the health authorities.

Since 2004, the Department allocated funding totalling €72,800 for a promotion campaign aimed at raising awareness of the telephone number of the Senior Help Line. The HSE advised that the telephone number of the Senior Help Line was circulated to all doctors' surgeries in the State. Summerhill Active Retirement Association received national lottery funding totalling €15,000 in 2003 to produce a booklet and promote the Senior Help Line.

In December 2003, the Health Service Executive supported an independent evaluation of the Senior Help Line. This was carried out by Dr. Eamon O'Shea of NUl, Galway, and launched last year by President Mary McAleese, who is patron of the Senior Help Line. The Health Service Executive has decided to support the implementation of the recommendations of the evaluation and this implementation is now well advanced.

The Senior Help Line has responded to issues of elder abuse since its foundation. Volunteers have received specialised training, funded by former health boards, provided by health service professionals specialising in the area of elder abuse, to enable them deal with calls of this nature.

Five per cent of calls in 2004 related to elder abuse. These callers establish a relationship of trust over a period 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 Help Line 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 Health Service Executive, has agreed to support further expansion of the Senior Help Line hours. Later this summer the service will also operate in the afternoons, expanding from a morning and evening service.

Each Senior Help Line centre provides support material for volunteers with key contact details of health services appropriate to dealing with elder abuse cases where the caller wishes for such an intervention. In addition to the Senior Help Line, the Government is committed to dealing with the problem of elder abuse. In 2003 the Government established the elder abuse national implementation group to oversee the implementation of the recommendations of Protecting our Future, the report of the working group on elder abuse which was commissioned by the Government.

Funding of €800,000 was provided in 2003, a sum of €750,000 was provided in 2004 and a further €900,000 was allocated in 2005 to continue the implementation of the recommendations of the report. Elder abuse is a complex issue and difficult to define precisely. It may involve financial abuse, physical abuse 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." In defining elder abuse this report will hopefully give older people, who feel they are the subject of abuse in any shape or form, the confidence to report their anxieties, as appropriate, to a social worker, a public health nurse, a member of the Garda Síochána or any professional or care worker.

It is important that the issue of elder abuse is 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.

Steering committees are in the process of developing clear policies and guidelines for the protection of vulnerable adults following wide consultations with staff. The committees are progressing their work through sub-groups 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 in older persons in continuing care settings.

In general, where problems occur with nursing homes, the inspection team which inspects the private nursing home will discuss its findings in detail with the owners or operators and this will generally ensure that the matters raised will be addressed. The HSE may remove a nursing home from its register or refuse to register a nursing home if it is of the opinion that, inter alia, the premises to which the application or registration relates do not comply with the regulations, or the continuance of services in the home will not be or is not in compliance with the regulations.

The Mercer Report on the Future Financing of Long-Term Care in Ireland, 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 from 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 in that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. This group has been requested to report to both the Minister for Social and Family Affairs and the Tánaiste by mid-year 2005. We expect to have that within a few weeks. 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 Health Service Executive areas, on developing standards for residential care for older people. At the same time the Irish Health Services Accreditation Board has commenced work on examining the development of accreditation standards for both public and private residential care for older people. It is developing a pilot programme that includes both public long-stay units and private nursing homes.

It will be clear to the House 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. The programme shown last night made it obvious that there are gaps in our legislation. It is the desire of the Government that these gaps be filled as quickly as possible and we have given a commitment to the people that we will do so.

This morning I mentioned that I would be meeting the HSE during the day. I can report to the House that the meeting took place. I sought a full report on the discussions that have taken place on this particular nursing home. I hope to receive that within a few days. I have outlined the agreement reached with the nursing home that should provide comfort for the patients there. I am also seeking a progress report in one month's time on how the new arrangements are working out.

Mr. O’Dowd

What about every day?

Mr. S. Power

A number of changes will have to be made and decisions will have to be taken on existing staff. I intend to keep on top of the issue. All Members are united in our disgust and shock at what we saw last night. It is important measures are put in place to ensure there is no repeat performance of what was witnessed.

Mr. O’Dowd

The Minister of State has been saying the same thing for years and nothing has been done.

Mr. S. Ryan

I wish to share time with Deputy Connaughton.

The horror story of Leas Cross nursing home shown last night has left a huge impact on Irish society. People were appalled to see large pressure sores on frail elderly people and flesh sores measuring eight or nine inches, with the holes going as far as the bone. The sheets were not changed so elderly people lay on wet sheets throughout the night. Care assistants shouted and intimidated elderly people, who shouted that they did not want to be dressed or undressed and wanted the care assistants to get away from them. I thought the use of restraining chairs was a thing of the past. There were patients walking around undressed from the waist down and residents walking around gardens at 7.30 in the morning seeking assistance. It was an appalling scenario.

The nursing home, the HSE and the Department of Health and Children were all aware of what was happening and must take responsibility for much of it. I am not making a political issue of this as I want something to be done. I welcome the statements and decisions made by the Minister of State, but the reality is somewhat different.

The recent report from the National Council on Aging and Older People revealed concrete evidence of discrimination against the elderly in health and social services. This is not new, as there have been a series of reports and investigations by Government and non-governmental groups into services for the elderly. Usually, the Government uses these reports as a shield to protect itself against claims of inaction in improving services for the elderly. I regret this is the route taken in the case, also.

The delay in establishing an independent inspectorate for nursing homes, which has been promised time and time again over the years, is a scandal that cannot be allowed to continue. In the past, people pointed the finger and said Members of Dáil Éireann were responsible. Since being elected to this House, however, I have consistently raised the need for legislation to address serious problems arising in nursing homes. I compliment Deputy O'Dowd and the Fine Gael Party generally for having raised these matters. The Labour Party has also raised these issues repeatedly and last night's television programme took the matter on board. On three or four occasions during the past nine months, I have called for the establishment of a nursing homes inspectorate. I furnished the media with reports and sent copies of them to specialist correspondents in various newspapers, but it did not seem to be a sexy issue for them. We were dealing with elderly people who in many cases could not support themselves. I warmly welcome the details that emerged from the television programme last night. I hope that, together, we can improve the environment in which elderly people live.

There is no statutory requirement to inspect the State's 500 public nursing homes which care for more than 10,000 people. Furthermore, there is insufficient staff to inspect all private nursing homes at least twice a year, as required under the Health (Nursing Homes) Act 1990. The Minister of State, Deputy Sean Power, may tell the media that he has only been in office for eight months but the facts have been well known to the Minister's predecessors in the Department of Health and Children, as well as to the departmental officials.

Mr. Perry

For years.

Mr. S. Ryan

The information was there long before that and has been well documented in the Department of Health and Children. In a letter dated 1 December 2004, the Tánaiste and Minister for Health and Children, Deputy Harney, in response to questions I submitted, acknowledged that a range of problems had been identified throughout the country by the existing, and totally inadequate, inspection system.

The Tánaiste said these problems included staffing levels and nursing policy issues, maintenance of accommodation standards, hygiene problems and a lack of activity for residents. Elderly people, who would prefer to be in their own homes but who were in nursing homes were taken out of bed at 8 a.m. and put sitting in chairs for the day. They had no activity during the day and were put back into bed at night.

Other problems included poor record keeping and insufficient or no active involvement by local authorities in fire safety matters. One can imagine that a nursing home could go up in flames leaving 100 people dead. Thankfully, it did not happen but it could have because there were major problems in that area.

In the same reply, the Tánaiste told me about a lack of equipment appropriate to clinical practice — for example, pressure mattresses. Pressure mattresses are the main requirement for dealing with bed-ridden patients suffering from bedsores. Anyone conversant with the needs of the elderly would be aware of that, but it seems that while everyone in the Department knew about it, they did sweet damn all about it.

According to the Tánaiste's reply, the problems included discrepancies in the contracts of care. I do not know what that means but, by God, it is another element of which the Department was well aware. Notwithstanding the information available about all the problems identified, nothing was done. Ministers told us repeatedly that the establishment of an independent inspectorate was in the pipeline, yet it was delayed for years.

One of the main functions of the social services inspectorate is to support child care services by promoting and ensuring the development of quality standards. However, although action for the elderly was promised for the past four years, responsibility for the elderly was placed on the long finger. If the Minister of State is really concerned about this matter, he should give the House a commitment to bring about improvements. Earlier, Deputy Rabbitte sought to ensure that the necessary legislation will be enacted before the summer recess. Deputy O'Dowd supported his request. We are prepared to wait until July, if necessary, to ensure that this important legislation is passed.

Independent inspections might well result in damning reports on standards in many of the State's public nursing homes, including nurse-patient ratios and the comfort of accommodation for older people. These facts may lie behind the State's reluctance to establish an independent inspectorate, but they must be faced.

Questions regarding the physical structure of nursing homes, as well as allegations of abuse and neglect, need to be addressed as a matter of urgency. Last night's special "Prime Time" investigation graphically highlighted these matters. The horror story of Leas Cross Nursing Home requires attention and action. We have had some comments from the Minister of State, but who will fund such action? Is the general public aware of the helpline to make complaints about nursing home care, and does the helpline operate across the country? I would like the Minister of State to respond to these points.

What we saw in yesterday's television programme was not just a case of elderly patients being stripped of their dignity — we saw a regime in operation that is putting the health and even the lives of vulnerable, elderly patients at risk. The Health Service Executive must take the necessary steps to rescue patients from these conditions, either by transferring them to other locations or by taking over the running of the home. I welcome the Minister of State's comments in that regard. For some time now there have been grave concerns regarding decisions taken by health boards, and now by the Health Service Executive, to privatise health care for people with intellectual and psychiatric disabilities. I refer specifically to decisions taken to discharge such residents from St. Ita's Hospital, Portrane, to Leas Cross nursing home and, pending transfers, to Blackrock, County Louth, and Stamullen, County Meath.

Mrs. Annie Ryan, who has been a great campaigner on behalf of people with disabilities, has put forward a range of queries which I now put to the Minister of State. What measures are in place to ensure the establishment of standards of care, the maintenance of these standards and their monitoring in private nursing homes? What arrangements are in place for the provision of advocacy for each resident who lacks capacity to make personal and health care decisions, or to manage property and affairs? In the event of failure to deliver the service in accordance with its contract with the HSE, what measures are or will be available to the Health Service Executive to protect this group of citizens who have hitherto been in the direct care of the State through the health authority?

The residents of St. Ita's were covered under the Mental Treatment Act 1945 and, as outlined in last night's television programme, they have been relocated to nursing homes where there is no independent inspectorate and where the conditions as outlined in the programme are appalling. That needs to be addressed. Many people are unhappy with the manner in which psychiatric patients and people with intellectual disability are being placed in nursing homes without proper care provided.

There has been no shortage of promises from the Government regarding the needs of the elderly, but turning these promises into reality has proved more difficult. The Minister of State said a good deal about the elder abuse prevention programme promised more than 12 months ago by the Minister of State who at that time had responsibility for services to older people, Deputy Callely. There are various types of abuse that older people have to endure and we know what they are.

The Health Service Executive has informed me that within the Limerick community care area, which was the responsibility of the Mid-Western Health Board — Deputies from the area should take note — a pilot project was initiated to investigate the issue of elder abuse and how it should be dealt with. In the short period of that pilot scheme, 98 cases were brought to the attention of the health board, with 79 being actively addressed. What happened? The pilot stage was completed in November 2003. To date, the Health Service Executive is awaiting approval from the Department of Health and Children to formalise the service through the appointment of the relevant personnel to re-establish this important service. This is a further example of the Department's lack of commitment to the elderly.

Actions speak louder than words, and we are looking for action, not promises made by the Minister of State and his predecessors, promises which were not delivered on.

Mr. Connaughton

I thought this day would not come. Like many people, I watched the television programme "States of Fear" a couple of years ago. In last night's programme there was a chilling parallel to what could have developed. We are talking of different times and different institutions, but what we saw last night was indignities piled on people who were defenceless in their beds. That was shown across the country last night.

RTE's "Prime Time" last night was of some service to the nation. I hope that lessons will be learned from the programme. It shocked people of all ages. Not alone did it show the neglect, indifference and downright rudeness, but, as I understood it, the programme revealed that some patients were paying more than €1,000 per week. An astonishing greed was involved in the service being delivered, and many people saw that in the programme.

Greed would normally not be associated with those who run nursing homes. The professionals in that area were always proud that their job was to provide a service to the elderly, irrespective of people's ability to pay. As a representative from east Galway, the nursing homes I know of provide an outstanding service. Other Members have expressed similar views tonight and no doubt others will do so tomorrow. I assume nursing homes throughout the country provide an excellent service, but last night's programme posed the question as to how we can be sure. How can we be 100% sure good service is being delivered? I know of people whose loved ones are in the Dublin nursing home referred to in the programme. Until last night, I assumed that many of those people believed the home was all right.

It is against this background that the Minister of State must do much more. I do not doubt his bona fides in this case, but his predecessors certainly took their eyes off the ball. Was there a sufficient number of inspectors, whether from the former health boards or from the HSE? Were they present to call at least twice annually on all 500 nursing homes? I understand that less than one third of the necessary manpower was available. The Minister of State may say differently tomorrow night, but that is my understanding. People thought they would be safe and that their best interests were being looked after, thinking that as far as the HSE was concerned, the inspectors were their great protectors, but it did not seem like that on last night's television programme.

I do not know, any more than does the Minister of State, if there is another nursing home with the same low standards as the one featured in the television programme. Are there ten, 15, 20 or 50 such nursing homes? Nothing the Minister of State said tonight gives me any reason to believe we are likely to know that in the next month, six months or couple of years.

Naturally, the Minister of State must take fire brigade action, and I thank him for doing so. I assume a brake will be applied and that what is going on in that particular nursing home will change, but what mechanisms will the Minister of State put in place immediately? It is no good talking of action which will be taken in two or three years' time. Much damage could be done if there are more rogue nursing homes such as the one shown up last night. I hope there are not many more like that, but until the Minister of State can enter the House and make freely available the exact information collected on every visit to all nursing homes, nobody can assure us there are not several more such nursing homes.

I hope we arrive at a stage where we have a mobile, fast and transparent inspectorate which will be single-minded with regard to visits to nursing homes, namely, that its members will visit the homes on behalf of the nursing home patients and nobody else. I look forward to the day I hear the Minister of State talk about that in this House.

Mr. Nolan

What was broadcast on national television last night was a scenario that is unacceptable to the Government, Departments and nursing home organisations in general. I suspect what we saw depicted on our screens last night is not common throughout the country. If the programme has done one thing for us, it has provided a wake-up call. It is a wake-up call to the authorities, the nursing home organisations and the public that we must be more vigilant. It is also a wake-up call for politicians. It has taken a programme such as the "Prime Time" special last night to outline what is going on in the country. We should have standards which are up to those the Department and the new Health Service Executive consider should be implemented.

What was shown on the programme are the shortcomings in our system. If we do nothing else, it is time we introduced legislation or regulations to shore up these shortcomings. The Minister of State, in his contribution to "Morning Ireland" this morning outlined the Government's position on the "Prime Time" programme.

There are hundreds of private nursing homes throughout the country and I am sure they were not very pleased by what they saw in a member home of their professional group as depicted in the programme. I am glad that news reports today outline that the organisation that represents nursing homes does not defend in any way what became evident last night. A number of people told me today that they could not watch and had to turn off their televisions because what was shown was so horrific. Anybody who has had to look after an elderly relation, family member of close friend has had that person's well-being at heart.

In a society where in many cases both couples must work, more of our elderly population will be put into the care of nursing homes whether private or public. An international report suggests that only 5% of the elderly go into nursing care. However, with an increasing number of people living longer, we will see an increased percentage in nursing homes. It is timely of the Minister to state that the Government is bringing forward legislation to cover some of the matters shown on last night's television programme.

We should not overlook the role of the Department of Social and Family Affairs in care of the elderly. Successive Governments have acknowledged the role carers play in their care. In the past few weeks the Minister for Social and Family Affairs outlined a major increase in respite grants for individuals who look after elderly people in their homes. This is an area the Government should examine. It should put more resources into funding carers who save the State incredible amounts of money by looking after elderly people at home. The elderly would prefer to be catered for in their homes rather than being sent to nursing homes, be they public or private.

The assistance given by carers is welcome and we will see more scope for assistance in this health area. The standard of care given by carers is extremely high and, from a Government point of view, is certainly value for money. Last night we saw that individuals pay up to €40,000 per year to have their relations kept in private nursing homes. We could keep our elderly in their home environment for far less than that.

The Minister must insist on random inspections for all nursing homes. I think we will see a shake-up in the quality and standards applied by nursing homes as a result of last night's programme. It is not right to give nursing homes advance warning of an inspection as it defeats the purpose of random inspections for the homes to be told they will be inspected at a particular time on a particular day. It is not good enough to say that the reason some homes are given advance notice is that they want the owner or matron to be there. If we have standards for nursing homes, the homes should be available for inspection on a 24-hour, seven days a week basis. I think that will happen.

The number of private nursing homes constructed in the past five or six years is substantial. Developers and entrepreneurs have seen this area as a profitable source of income. Nursing homes are more than just a business. If business people want to get involved in nursing homes, that is all very well, but they must employ professional health care people with an experienced background in the nursing home sector. They must employ professional nurses and administrators and suitably qualified matrons who have a working knowledge of how to deal with and care for the elderly.

It is not acceptable that foreign nurses and assistants are employed as carers in nursing homes to the extent outlined last night. Our elderly would not be familiar with non-nationals and foreign carers and would not have had much exposure to them during their lives. It is unfair to have them looked after by foreign nurses. I do not mean to criticise the standards or qualifications of overseas nurses, but there should be a quota system with regard to the number caring for elderly patients.

As a result of the pressure on couples to work because of high mortgages and the high cost of housing, fewer families, individuals and couples are in a position to look after their elderly patients or relations in the home.

Debate adjourned.

Dáil Éireann díospóireacht -
Tuesday, 31 May 2005