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Dáil Éireann díospóireacht -
Wednesday, 1 Jun 2005

Vol. 603 No. 4

Private Members’ Business.

Nursing Homes: Motion (Resumed).

The following motion was moved by Deputy Twomey on Tuesday, 31 May 2005:
"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."
Debate resumed on 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."
—(Minister of State at the Department of Health and Children, Mr. S. Power)

I wish to share time with Deputies Wallace, Devins and other Deputies who may join us later, by agreement.

Is that agreed? Agreed.

I am pleased to have the opportunity to speak on issues related to the provision of services for older people. I begin by clearly stating my upset and shock at this morning's newspaper coverage across all publications. We have witnessed incredible, vile images over the past three days. At times, we shoot the messenger and complain at the manner in which sections of the media invade private life on a topic of the day. On this occasion, the production team of "Prime Time" must be complimented and applauded for its investigations.

We could reflect on the horrific images of elder abuse and compare and contrast these with the serene, well designed, beautiful, manicured parkland and buildings that house nursing homes across Ireland. God knows what goes on behind their doors. However, it is important to state that there are some fantastic and world class facilities available for the care of the elderly, with caring, compassionate and dedicated staff. This House must provide the supports necessary for the statutory authority to be satisfied at the quality of care provided in such homes. Violation of an elderly person's dignity is a clear depiction of human injustice. Sadly, this injustice could be happening just footsteps away. It is time an experienced third party is appointed to investigate clear acts of depravity that are taking place in certain nursing homes throughout the country.

I am sure the House will understand my strong view on this matter as I served as Minister of State at the Department of Health and Children, and always took a genuine interest in services for older people. While I have moved on, my thoughts are with the relatives, friends and patients of that nursing home. This week I have already discussed the Leas Cross case and the structural changes being put in place with the chief executive officer of the regional HSE. Although I have moved on, my interest remains.

We should give serious consideration to the implications of these structural changes because they are being rolled out as if the problem is solved. However, they have an impact on existing services. Furthermore, as the media shone an extremely bright light on a dark issue, we now need to encourage whistleblowers to step forward and request investigations into any matter about which a relative is concerned. We need justice for people in the autumn of their years — men and women who worked hard to build this country and create the world we enjoy today. As I have often stated, it is their hard work and tireless vision we can thank for the creation of our society.

I reject the low political ploy of using such an important national issue, as was done by Deputies Twomey and O'Dowd yesterday. It was cheap dirt. I will not lower myself to their cheap tricks. However, it is important that I correct the record. If Deputies Twomey and O'Dowd are men enough, they may wish to correct their position.

Deputy Twomey referred to a case brought to my attention and stated: "He probably whispered it in somebody's ear and left it at that." That is an untruth; it is a lie. If Deputy Twomey talks to Deputy O'Dowd, he knows it is an untruth. Deputy Twomey later stated: "Those of us who have been involved in medical services [as Deputy Twomey has] know that all is not well."

We do not know whose ear the Minister whispered in. What did Deputy Callely do as Minister of State?

Does that comment by Deputy Twomey not give rise to a number of questions?

The Minister of State should answer the charge. What did he do as Minister of State?

Equally, Deputy O'Dowd asked the question: "What did the Minister, Deputy Callely, do about it when he was told about it in a letter from Beaumont Hospital?" Deputy O'Dowd knows the answer. This was not a Leas Cross case.

What did the Minister of State do to change the situation he described as vile and incredible? He did nothing.

I did much more than most when I received a case from a person outside my constituency in a constituency clinic on the morning of Saturday, 14 February 2004.

The Minister of State had responsibility for the elderly, yet he did nothing.

I did not refer the upset daughter of an elderly mother in a nursing home to a colleague in her constituency. I dealt with the case there and then. I followed up the paperwork on the Saturday evening. Both the daughter and the statutory authority received correspondence from me on Monday, 16 February 2004, and I received confirmation from the statutory authority on 18 February 2004 that the case was being investigated, which I forwarded to the daughter on 19 February 2004.

The question is Deputy Callely's role as Minister not as a Deputy.

The Minister of State should conclude. I call the next speaker.

Thank you. A further issue referred to in this debate was the elder abuse report. When I received that report in November 2002, I ensured money was made available to commence implementation of its recommendations in 2003 and to continue progress by further funding in 2004.

The Minister of State should conclude.

I have a proven track record of achievement while in the Department of Health and Children, including the setting up of the interdepartmental group on the needs of older people——

The Minister of State did not change the inspection regime. He did nothing.

——improved funding for voluntary groups, the first ever funding for the national helpline, development of personal care packages and home supports, rapid access clinics and new community units at the Meath Hospital, Hartstown, Glasnevin, Birr, Virginia, Lusk, Our Lady's Hospital, Harold's Cross, Maynooth, and many more from Malin Head to Mizen Head. I took an innovative, fresh and holistic approach to the needs of older people. I contributed to improving the lives of thousands of older people, which was my priority during my tenure and continues to be a priority for the Government.

My last remarks on this matter are personal. If I had a loved one in care, I would be concerned for his or her welfare. Apart from visiting as often as I could, I would make sure he or she received the love and attention he or she deserved. There are many wonderful nursing homes here providing a world class service.

The Minister of State should conclude.

However, I would urge relatives and friends to continually keep an eye open to make sure that the service offered is the service provided.

The Minister of State has taken seven minutes so that means——

I am sorry but I thought it was important to correct the record.

The time will be taken from your side. I call Deputy Mary Wallace.

I would like to begin by saying-——

It is a pity the Minister of State did nothing to change the nursing homes inspectorate regime. That is the charge against him.

I heard about Deputy O'Dowd in Dundalk, and about his negative, absolutely damn all approach. A load of Horlicks is all he did in regard to three cases I have under investigation.

What is the Minister of State talking about?

I would like to begin by saying that the findings of the "Prime Time" programme——

What is the Minister of State talking about?

Order, please. I call Deputy Mary Wallace.

The people of Blackrock are not too happy with Deputy O'Dowd.

Over what?

I will give the Deputy the detail.

It is the back of a cardboard box and no action.

This is not fair on other speakers.

The Minister of State is making personal charges.

I would like to begin by saying that the findings of the-——

I would be happy to produce the record so we can put this right. However, Deputy Callely did nothing as Minister of State to change the nursing home regime. He sat on his butt and did nothing.

That is wrong; it is a lie.

He did zero, zilch, absolutely nothing.

I would like to begin-——

The Deputy is telling lies. Sorry, I will correct the record: he is telling untruths.

I hope Fine Gael will give us this time because much of the time of other speakers has been lost. I would like to begin by saying that the findings of the "Prime Time" programme were shocking.

The Minister of State is a disgrace.

Deputy O'Dowd is a disgrace.

This is shameful.

It is unbelievable and unacceptable that older people would be subjected to the type of environment portrayed in the programme. It was horrendous viewing for all of us but particularly for families whose elderly relatives are in nursing home care. For the sake of all our elderly citizens who reside in nursing homes and their families, it is exceedingly important that the commitments given in recent days are honoured, in particular with regard to action and ongoing monitoring at Leas Cross, and also regarding the independent inspectorate for all nursing homes.

It must be said that there are many excellent care facilities and nursing homes in all areas and many wonderful nurses and care staff who provide an excellent standard of care and attention for our elderly friends and relatives. It is extremely important in this debate that we have balance in what we say to ensure that we do not make the mistake of tarring everyone with the same brush.

In light of this week's revelations, there is no doubt urgent changes are needed to ensure the nursing home inspection teams cease the practice of providing advance notice of pending inspections. It is ludicrous for any inspectorate to give notice of a pending visit as this will naturally ensure that major advance preparation work is done to have all in place, including staff ratios, for the time of the visit. It is akin to providing this year's leaving certificate students with the exam papers a week in advance. Until this week, I had presumed the nursing home inspectorate operated on the same basis as the child care inspectorate, in that it could arrive to inspect a facility completely unannounced and at any time. Anything less than this type of inspection is a waste of time and the nonsense of advance notification must cease immediately.

It is important to note that most families care for their elderly relatives in their own homes for as long as possible. When this is no longer a possibility, they are dependent on the availability of high quality long-term residential care.

I thank the Minister of State for his positive comments regarding the wonderful work of the Senior Helpline which is operated by the Summerhill Active Retirement Association from its County Meath base. Since 1999 the helpline has received more than 10,000 calls from lonely older people nationwide. It reminds us all of the importance of communication with the elderly in our community.

I welcome the Government's work in respect of the home care grant scheme which operates on a pilot basis in many areas, providing support for families caring for the elderly in the community on the same basis as nursing home subvention support. This pilot grant scheme has not yet been extended to families in County Meath who care for elderly relatives in their own homes. Will the Minister of State ensure provision of the scheme in County Meath at an early date as it would be a marvellous help to these families?

This week provided a wake-up call with regard to nursing homes and from now on we should hope to see changes across the board. The two most important issues are the ongoing monitoring of the situation in Leas Cross and the commitment with regard to the independent inspectorate.

The shocking revelations contained in "Prime Time" have rightly precipitated enormous anger. The demographics of our society clearly indicate that the number of elderly people in Ireland is rising rapidly. In 2002, 11% of our population was over the age of 65 years. By 2030 that figure will have risen to almost 21%. This has important implications for the country. How the elderly will be cared for and how this care will be financed are two of the issues which must be addressed.

Care of the elderly is a complex issue. I have today written to the Chairman of the Joint Committee on Health and Children, Deputy Moloney, asking him to prioritise the issue in our work programme for the immediate future. A wide range of supports are available from care at home to long-term care in nursing homes and geriatric hospitals. The total cost of care for the elderly this year will be more than €1 billion. Undoubtedly the best place for an elderly person to obtain care is at home. The provision of home help packages should be extended and programmes such as Choice, a pilot programme operated in Sligo by the Health Service Executive north-west area, should be rolled out nationally. This excellent programme gives valuable support to elderly people.

I wish to raise the issues of inspection and supervision. Many long-term care institutions provide excellent care to the elderly, but some do not. I welcome the Minister's announcement of an independent inspectorate and urge him to resource it adequately and establish it without delay. It must have teeth so that deficiencies can be identified and responded to immediately. Any inspection visit should be unannounced and completely thorough. The inspectorate's remit should extend to both public and private facilities. Most will have nothing to fear and well run institutions will welcome such inspections. Elderly people need protection. Relatives and friends can act in loco parentis but, unfortunately, many elderly people in institutions do not have such support. The State must act on their behalf so that the appalling, degrading and brutal scenes witnessed on “Prime Time” are completely eradicated and those who perpetuate such acts are removed from care of the elderly.

I welcome the opportunity to speak on this matter and share in the shock and horror expressed by my colleagues with regard to the revelations made in "Prime Time". It is a pity that it takes media exposure such as this to spur everybody into action. However, I welcome the Minister of State's announcement with regard to establishing the social services inspectorate on a statutory basis. He will also publish a Bill by the end of the year which deals with training, the rights of patients and other important issues which have major consequences for the elderly in public and private facilities.

There was no mention of this issue in the programme for Government or the Government's legislative programme. However, it is better late than never. I have met many different nursing home groups over the past 12 months and would not like for people to think that there is large-scale abuse in all nursing homes. Many of them are very well run and many private nursing homes will welcome the fact that the inspectorate will examine both public and private facilities as this is a development they have been seeking for some time. Therefore it is somewhat surprising that legislation in this area has not been forthcoming before now.

The Government has invested a great deal of money in care for the elderly over recent years. However, there is an issue which has been of some concern to me and I have raised it in respect of all health related matters in the Dáil recently. Many of the current care packages to care for the elderly are geared towards Dublin and the eastern region. I refer specifically to the ten-point plan to deal with the accident and emergency crisis. Of the 500 additional home care grants which have been allocated, 400 are for Dublin and 100 for the rest of the country. How many additional home care packages will that mean for County Mayo?

The Minister of State highlighted that the maximum rate of subvention based on maximum dependency is approximately €190. However, the discretionary payment that the Health Service Executive has applied in the east of the country is an additional €300 to €400 per week. This means that a person in County Mayo can get a maximum subvention of €220 per week and if they are fortunate enough to be considered a hardship case, they will get €300. However, another elderly person in similar circumstances will receive €600 per week. I raised the matter with the Tánaiste who acknowledged the problem and said that she knows of nursing homes on different sides of the same street which fall into separate health board areas and get a different rate of subvention. We must bring uniformity to the system.

Regarding contract beds, tenders were recently taken throughout the country for 500 additional places for intermediate care and 100 places for high-dependency care. I see from the Minister of State's notes that he has procured 95 beds for intermediate care and 47 for high dependency, but not one is in County Mayo. Virtually no nursing home in County Mayo tendered for those contract beds. I have come across two and both have been rejected. The reason they did not apply in the first instance is that when they contacted the Health Service Executive, they were told they had to have a minimum of ten beds available. Why must a nursing home in County Mayo have ten beds available when only 97 are required throughout the entire country? It is illogical and makes no sense. It means that those three aspects of the ten-point plan have virtually no relevance in County Mayo. I highlight the issue because it is all part and parcel of care for the elderly. Problems in accident and emergency services and nursing homes are not restricted to the cities. They exist throughout the country and if we are to address the issue seriously, we must do so on a countrywide basis.

A great public service was once again done by "Prime Time" in highlighting this issue. It focuses us on the treatment of the elderly within society. The situation has changed over the years. Long ago we revered the elderly in our community but now we seem to push them aside. This is evidenced by the busy activity of helplines established to aid elderly people. Some 50% of calls to the Senior Helpline are as a result of loneliness. This should force us all to look at what we can do in terms of responsibility. We need to ask whether we are talking to the elderly in our community rather than merely dealing with the obvious crisis of the treatment of those in nursing homes.

I welcome the changes that will take place and the fact that the Government has committed to putting the social services inspectorate on a statutory basis. The sooner it happens the better. I would welcome that.

There have been calls for new legislation but the existing legislation is sufficiently stringent if it were properly enforced. That is the bottom line. Regardless of the requirements or guidelines, the most important relationship an elderly individual will have in a nursing home is with the care workers who work with him or her. They should treat the elderly person with respect in their engagement with that elderly person but on the television programme we witnessed a man shouting at an elderly woman. That is terrifying and it is dreadful abuse of a very vulnerable woman. Regardless of the legislation we have in place, if an inappropriately qualified individual, in doing a job like that, is instilling terror in an elderly person it will not improve matters. Guidelines and stringent legislation are required but equally having appropriately skilled people is very important.

The Dáil has called for legislation to be enacted during this session but in that regard we are damned if we do and damned if we do not because the Government is criticised when legislation is rushed through the House. This is an important area and one that has not been highlighted just this week. We need to reflect properly on it and put good legislation on the Statute Book.

Hear, hear, and we must do it quickly.

I wish to share time with Deputies Finian McGrath and Gormley, although I am not sure of the arrangement. We may have to change it mid-stream but perhaps someone will stop me in time.

I welcome the opportunity to speak on this motion. The motion is very timely, although it is not the happiest of subjects to be discussed, in the wake of the chilling TV programme we witnessed on Monday night.

It is important to state at the outset that there were adverse reports on 43 of these nursing homes out of a total of 440. It is not all bad, therefore, but I have no doubt that many people will have second thoughts about placing their relations in a nursing home and I am sure many elderly people are very concerned about being placed in nursing homes. I can imagine the discussions in some households about whether one should be put into a nursing home and the fears in that regard.

I support the call for an inspector for nursing homes but it is not just about creating an inspectorate. We have had similar situations in the mental health area, of which I am well aware, when visits from the mental health inspector were often forewarned and therefore meaningless. There was often upwards of a month's notice that an inspector would call and human nature being what it is, people will tend to put their best foot forward. I hope that as part of the policy inspectors will call to nursing homes unannounced, that they will call regularly and that if complaints are received from particular nursing homes they will address them.

The cross-Border aspect of the nursing home provision is important also because we are subventing patients across the Border. Also, we must cater for both the physical and mental needs of patients. We can care for patients very well physically but they need mental stimulation, activities etc.

I welcome the opportunity to speak on this important motion on the nursing home issue and the urgent need for proper inspection procedures and quality care for our elderly and disabled. I support the motion but I urge all Deputies to be sensitive and respectful when dealing with such an important matter. There is a responsibility on all of us to act in the interests of our citizens. It is not acceptable to have people treated in an inferior manner.

Good practice, professionalism, quality care and respect for the person are the key issues in this debate. As the parent of a child with Down's syndrome and a member of Down's Syndrome Ireland, I was shocked and horrified at the treatment of Peter McKenna. This man, who had Down's syndrome, was sent home from St. Michael's House by a High Court order despite objections from his family when he developed Alzheimer's disease shortly after his 58th birthday in 2000. His family told the programme that he missed a hospital appointment during his second week at home. His sister, Mary Moore, said he was brought to Beaumont after two weeks in Leas Cross. The hospital found that he had been dehydrated for at least two or three days. Hospital medical notes stated that on admission his level of hygiene was poor and his urine bag contained infected looking urine. Peter died within a few hours of getting to the hospital from blood poisoning. That terribly sad case has moved us all and I urge that it should never happen again.

This debate must also be about family responsibility and support and the urgent need to assist our carers. Turning a blind eye to the urgent need to support our carers is not an option. I call on the Government, and particularly the Minister of State and the Minister for Health and Children, to give our carers the maximum financial support. Other former Ministers, like the Minister of State, Deputy Callely, should seriously consider their position in regard to this issue and related matters.

I want to raise the sad case of a constituent of mine and the way he was treated in James Connolly Memorial Hospital, Dublin. The family and relatives of this man were extremely distraught about the conditions in which he was kept. I have already passed the details to the Minister and I urge action in improving the conditions and services to the elderly in this hospital. It is simply not acceptable to have patients left in cold and inhumane conditions. When elderly people are treated in this manner it is a clear breach of their human rights and an attack on their dignity as a human being. I urge all Deputies to forget about party politics and support the elderly in this debate.

At the outset I congratulate the "Prime Time" team for a wonderful job of investigation. It was a great example of public service broadcasting and those in this House owe them a debt. It indicates that our licence fee is being well spent when one sees the quality of that programme.

Many people told me they were shocked by the programme, and it is a case of seeing is believing. The hidden camera has revealed the depths to which we have plunged in this country. Today I was contacted by a nurse who has worked in this field and who shocked me even further by her revelations. She analysed it very well because she said she has worked in this field for many years and she contrasted what she saw as the good old days when our hospitals and nursing homes were run by the religious. She said there was a massive contrast between what occurred then and what is occurring now. She said the homes that continue to be run by the religious are second to none and the quality of care in them is fantastic.

A new ethos has emerged. It is about money and profit and it is as a result of the new avaricious policies promoted by Fianna Fáil and the Progressive Democrats. It is about profit and the patient is no longer seen as a human being but as a commodity and therefore we get many shortcuts. She explained to me how this could occur. For example, cheap staff are employed who are not motivated. They do not have the vocational calling of the religious. It was not just about care. They are there to do a job they do not particularly like in many cases.

This nurse worked in Church View, Cabra, and she said the set-up there was appalling. The nurses' aides work at night but they want to sleep and if patients wet themselves, they simply change them without properly drying them. As this nurse explained, the uric acid would infect the patient leading to the development of bedsores. That was one example of nurses aides taking shortcuts because they did not like their job and they wanted to sleep. It is disgraceful. She also said that elderly people would receive a glass of milk for lunch. If one asked for another glass of milk, it was not provided. She was shocked by this strict rationing motivated by profit. The bread they were given was already buttered and if a patient requested more bread, it was not available. Those elderly people suffered because they were hungry and they were dehydrated. She paints a shocking picture and if this is the revelation coming from one nurse, the problem is much more widespread that any of us could have believed.

She also confirmed that ambulance drivers who were familiar with the house had made similar complaints. She went to the local health board and the only response she received was that it would work with the home to try to improve the situation. There was no real sanction as the health board did not have the teeth in terms of legislation to deal with this awful situation. Patients were put into a dark basement that seems to have been like a dungeon. These patients were fed by tube and had no therapy. They could not get out and it sounded like they were incarcerated. If "Prime Time" had made a programme on that home, we would have been even more shocked.

We have a problem that is widespread. The woman told me about another home in Rathmines where she worked that has since closed. Patients there were given Valium without prescription so they would go to bed at eight o'clock and staff would not have to deal with them. They were, as she put it, doped out of their heads. This is what has been going on and we have ignored it. We can no longer do so. We need legislation in this House to deal with it. I congratulate members of Fine Gael on tabling this motion and it has my full support.

The question in people's minds is very simple. Why did all the organs of the State fail to protect these vulnerable older people? Why did it take a television programme to expose the scandal when these homes are supposed to be governed by the rule of law, bound by regulations and subject to inspection?

Relatives of victims at Leas Cross told of their concern at what they had seen on visits to this nursing home. The health board, and later the Health Service Executive inspectors, failed to protect these elderly people. The reason was summed up by one member of Leas Cross staff who was secretly filmed after an inspector's visit. She said that they were concerned by the paperwork. That is surely a damning indictment of the bureaucratic mindset.

We have long needed an independent inspectorate of nursing homes and we now need it urgently. The Government tells us we will have legislation to establish such an inspectorate later this year. When will the inspectorate be established? Will it be a year after that or two years? For some elderly victims of abuse in nursing homes it is too late. They have died of neglect, like the victims highlighted by recent television exposé. Vulnerable elderly people should not have to wait for the independent inspectorate to be established. The Minister for Health and Children should immediately appoint additional inspectors throughout the country and ensure that all nursing homes are inspected within the next two months. This should not be done by prior notification but by cold-calling, not once or twice but as many times as is necessary to satisfy everyone that we have the highest standards possible.

The many people who run nursing homes responsibly with the highest standards of care would welcome such a move, as the scandal of Leas Cross casts a shadow over all nursing homes. It is appropriate to commend all who manage and work in nursing homes where the required standards are met and maintained at all times. Great credit is due to those who give dedicated service to senior citizens and the most vulnerable in society. They must be acknowledged. We can be certain that Leas Cross is by no means an isolated case. I think the Minister of State accepts that. The great fear is that what we have witnessed is being replicated in other nursing homes. It is abhorrent that we spend millions of euro of public money which effectively pours into the pockets of the unscrupulous owners of these institutions. The HSE effectively abandoned people to the regime for which the owners of Leas Cross, the Ahernes, were responsible. What sanction will they now face? Will public money still be paid into their coffers? These are questions we need to have answered.

Nursing homes qualify for so-called tax incentives which the Minister for Finance is reviewing but which the Minister for Health and Children wants to extend to private hospitals. I have tabled a question to the Minister for Finance asking if Leas Cross benefited from this tax bonanza. Perhaps the Government could come back on this matter before the end of the debate. Would the Minister of State at the Department of Health and Children note, as I put it to the Minister for Finance this afternoon, that Age Action advises that at least €500 million of public money has been ploughed into the private nursing home sector since the relief was introduced in 1997?

Sinn Féin tabled an amendment to the Disability Bill that would have stipulated that all disability specific services in the State be managed in accordance with Articles 3 and 8 of the European Convention on Human Rights. These articles deal with the right to privacy and family life and the prohibition on torture, inhuman and degrading treatment. The Government disallowed the amendment on the basis that to allow it would impose a charge on the State. That was just last week. I cannot believe that Government Deputies are proud of that now in light of Leas Cross. That kind of situation was what the amendment would have dealt with.

To prevent abuse or neglect we need a single, common high standard of care of the elderly in private, public and voluntary nursing homes and for those cared for in their own homes. I hope this scandal makes the Government pay heed to the Human Rights Commission established under the Good Friday Agreement. The commission highlighted the lack of protection for old people in nursing homes in its report of November 2002 but the Government did nothing.

A number of public bodies need to answer hard questions. On the Leas Cross website the owners boast that they are certified as service providers for the northern area health authority, the south western area health authority, the east coast area health authority and the VHI. Leas Cross carries a certificate from EQA, a quality assurance firm based in the north of England. Surely its integrity must be questioned by this scandal.

The current lack of proper regulations and the lack of an independent nursing home inspectorate is a disgraceful situation. It is incredible in this day and age that such an important factor in our society, care for the elderly, is being overlooked and placed on the back burner. Many of the people in nursing homes are responsible for the success of the country. They have worked hard for most of their lives and have made the State what it is today. We owe them a deep debt of gratitude for what they have done for us. At a minimum we owe it to them to ensure they have a proper lifestyle and are treated with dignity and respect. To ensure this happens in nursing homes, we must have proper regulations and structures in place.

The current abuse highlighted by RTE is evidence enough that there is a need to establish an independent nursing home inspectorate immediately. Such an inspectorate should be for all nursing homes, whether public, private or voluntary. It should have the necessary powers and resources to allow it to carry out its functions fully. It is vital that the inspectorate is composed of the appropriate professionals in order to examine all aspects of nursing home services. It must have the necessary resources and powers to implement changes and make necessary improvements.

The reports of all inspections must be made publicly available so everyone can be informed of any issues that may arise. These reports should be available free of charge to everyone, so there is adequate information and transparency about standards in our nursing homes. People cannot be shut away and forced to live in substandard conditions. The general public should be made aware at all times of the conditions in which our senior citizens are living.

Elderly people are in a vulnerable position in our society and may sometimes be dependent on others to cater for their needs. We cannot condone these people being shut away in nursing homes, while ignoring the standards of care involved. We have moral and legal obligations to take care of the elderly. In order to fulfil these obligations, I call on the Government to act immediately to implement the required proposals. To this end, the Government should waste no time in bringing the necessary legislation before the House. It is not good enough that anyone requiring our help should be abused in any way. This situation must be rectified immediately.

I have read the Minister of State's remarks as reported in the newspapers. I know he is genuinely sincere in what he is attempting to do.

The MRSA superbug nearly took my life last year. What chance have we got if nursing homes are allowed to operate in which the MRSA superbug is rampant? If people are allowed to develop bedsores, as we saw on that television programme, what chance have we of combating MRSA? Last October, the Tánaiste and Minister for Health and Children, Deputy Harney, made a commitment to me to investigate how I was treated when I contracted the MRSA superbug. I am lucky to be here today to raise this matter in the House. I ask the Minister of State to consult with the Minister and ask her to report to me on whether the treatment I received was adequate.

I nearly lost my life as a result of the superbug. We cannot allow the MRSA superbug to continue its grip on our hospitals. Something must be done. If it happens in prisons or anywhere else we will be in dire straits.

I wish to share time with Deputies Crawford, Ring and McManus.

Is that agreed? Agreed.

Although I am disappointed that such a motion should be before the House, I welcome the opportunity to debate it. A nation should surely be judged on how it treats its elderly and how they are taken care of after a lifetime's contribution to the State, including the development of the economy. The State should not ignore the plight of the elderly when they are unable to care for themselves or when they are so frail that their families cannot care for them either. That is what is happening, however, in a small number of nursing homes where people are being mistreated.

It is only fair to say that the majority of nursing homes do an exceptionally good job. Their contribution to the elderly is above reproach and I have had personal experience of that with my own family. I have nothing but the height of praise for the nursing homes with which I have dealt. However, the television exposé on Monday night was a matter of shame. It is a shame that such treatment is tolerated despite Opposition demands that something should be done. The first such exposé was in 1984 when another television programme revealed what was occurring in a nursing home. In the interim, we seem to have learned very little.

In 2001, Deputy Gay Mitchell introduced a motion in the House highlighting difficulties and concerns about nursing homes. The Government amended that motion on the basis that it was acting, and would act further, on the matter. We find, however, that so little has been done. We need to establish immediately a properly financed inspectorate for all nursing homes, which must be independent of the Health Service Executive. I wonder if the executive is functioning because I understand it does not even have a fully appointed chief executive.

I am concerned about the inspectorate of mental hospitals but at least its annual report is published. The details of inspectors' visits to all mental hospitals are publicly available. All Deputies have a copy of the report of the chief inspector of mental hospitals, so why does the same not apply to the inspector of nursing homes? There are 423 nursing homes, yet only 80 were inspected annually, while all of them should be inspected twice a year. That identifies a lack of commitment by the Government and the Minister to ensure that proper inspections are taking place.

Working groups were established by the previous Minister, Deputy Martin, whose approach was always to set up a committee to deal with such problems. The committee established after the 1998 report, reported in 2002. The recommendations of that committee, including that the social services inspectorate should be extended to all community and residential services for older people, have been ignored. It also recommended that, at a minimum, a staff structure should be put in place in each health executive area. That structure was to have included a steering group and a dedicated health board officer in each community care area with responsibility for preventing abuse of the elderly. It also recommended that a senior case worker for each community care area should be employed by health boards, as well as a support service. Those were the minimum requirements.

Abuse is an emotive term but there is no other description for what we saw in the television programme earlier this week. Last week, I met an elderly person living in their home. They are unable to take a bath, so they have sought a shower installation. We do not know if they will get a shower or, if they do, in what year it will be installed. The Minister of State should do something about special housing aid for the elderly. If it is not applied properly it can also be a vehicle for abuse.

I welcome the opportunity of speaking in this debate on nursing home care, including care for the elderly and the disabled. It was totally frustrating to listen to the Taoiseach this morning stating that the Government had improved home help and home care. In counties Cavan and Monaghan, which I represent, the number of hours allocated for such care has been cut in half. Individuals are no longer being allocated care on an hourly basis, but by the minute. In addition, home help carers are being asked to fill in mileage forms that are virtually impossible to understand. The allowance is 19 cent per mile, but that is only from the home of the first patient to the home of the last one, provided they are in the one administrative area.

There are many excellent nursing homes in my constituency and my late mother was a beneficiary of one of them. They provide an excellent service to the aged and the handicapped. There is always a need for proper supervision. I fully support my party's demands for that regulation to be put in place immediately. A person or family must have the right to move from one nursing home to another if difficulties are encountered. That freedom to move is important. If the owners of nursing homes know clearly that people can move if they do not provide a proper service, that will be more important than anything an inspector can do.

Another major issue involved in the care of the elderly is the lack of funding for nursing home subvention. In my area of Cavan-Monaghan we have the most severe difficulties of anywhere in the country. On many occasions we have people in their 90s on waiting lists to get subvention because insufficient funding is provided. Nursing homes must provide heat, care and attention of all sorts. Their costs have increased dramatically over recent years as a result of direct charges for waste, increased fuel prices, increased labour costs and so on, yet there has been no increase in the subvention. It is difficult to explain to a 99 year old that out of a budget of more than €11 billion available to the Tánaiste, home care subvention for those who have established the State cannot be provided.

I welcome this debate organised by the Fine Gael Party. It has coincided with RTE's "Prime Time" programme which clearly exposed the failure of the Government to oversee the needs of the elderly and care for them. We in Fine Gael have offered to extend the Dáil sittings into July to have the necessary legislation introduced. It is vital that the Government take up that offer and deal with this critical issue now.

There are cases in my constituency where some difficulties were encountered, but the majority of nursing homes do an excellent job, which we must recognise. However, the funding must be put in place to ensure that all nursing homes can function properly and that the elderly and disabled are properly looked after.

Why does it once again take "Prime Time", a national TV programme, to highlight such a matter? I recall that in 2001, when the Minister of State with responsibility for older people was in this House, I raised an issue regarding a nursing home in north Mayo. I will inform the House of the response by the State and the health boards. I received a complaint from a family member and went to the nursing home, unannounced, on a Saturday evening. The matron did not want to let me in. I said I was going in because as a publicly elected representative I had a right to see for myself what was going on. I told her I had received a complaint and was investigating it.

I returned to this House and put my comments on the record. A Member of the previous Dáil, a colleague of the Minister of State, Deputy Brian Lenihan, saw the charade by the health board, which could not cover up what had happened quickly enough. It used a substantial amount of money — and I take the credit for that action — in bringing that public nursing home up to a standard whereby people could at least feel they were in a nursing home rather than endure the conditions I saw on the night I visited. I put all that on the record of the House.

I will inform the House what happened three weeks later. It reflects what is taking place in this country. It is time for the Minister of State and his colleagues to realise it. He and the health officials are paid by the State, taxpayers in effect. Health officials must own up to their responsibilities. They are all running for cover and away from the problem, with none of them taking responsibility.

When I raised the complaint about the nursing home in this House, the Western Health Board cleaned up the problem. It organised an open day. There was a big charade with all the elected Fianna Fáil representatives who brought local radio representatives with them. The sad thing was that the Minister who visited the nursing home on that day thought he was fooling the people there. The people spoke a few months later. The Minister was not re-elected, while I got the largest vote ever seen in that area.

This is unworthy of the Deputy.

The people knew that what I said was the truth. The charade did not work. Charade is all the Government is good for.

Where Mayo is concerned, the Deputy is the master of charade.

Like the Minister, the Minister of State is all talk and public relations. The Minister for Health and Children informed the House she would make the elderly a priority. We have not seen evidence of that in the House during this debate. If the elderly are such a priority with her, why is she not present? This is the most serious issue the State has faced since its foundation because we will all be judged on how we look after our elderly. Whether the Minister of State likes it, he too will become elderly. He will want to be judged by the people coming behind him and will want them to look after him. If we cannot look after the people ahead of us, we are a sad people.

I raised this issue on many occasions. The Minister of State can check the Adjournment debate. I regularly asked in the House for an inspectorate for both public and private nursing homes. We had a daft situation. The State — the biggest culprit in this area — did not have its nursing homes inspected, while the health boards gave advance notice of when they would inspect the private nursing homes. The whole affair was a joke.

I compliment "Prime Time", but it is sad that we do not listen to Members of this House and do not take them seriously any longer. Today, the Minister for Justice, Equality and Law Reform announced the Morris tribunal report, but that should have been done in this House, not at a press conference. It is no wonder people in this country no longer vote. We have no respect for ourselves in the House nor any respect for the House. I know the EU constitution has nothing to do with nursing homes, but it is no wonder that the people of France and the Netherlands rejected that constitution and that the people of this country will do so as well. We are sick and tired of being dictated to from those abroad. We are sick and tired of being dictated to by officials elected by nobody and answerable to nobody, not even to the Minister any longer.

If the officials with responsibility for nursing homes were doing their jobs, we would not have the situation seen on "Prime Time". I compliment RTE on investigating the situation and doing a proper job. We have some great public and private nursing homes but we must deal with people who are in the business only to make money and who do not care how they look after our elderly.

The Minister of State and the Government should note that in 2001 we were promised inspectorates. We are now in 2005 and the Dáil is closing down next week. There is no need for that. Let us bring in the emergency legislation to deal with this matter next week. If that legislation is brought before the House, we will play our part.

I would like the officials of the Minister of State to follow up on the matter I now raise. The "Prime Time" programme showed quite shocking procedures at the Leas Cross nursing home but I am given to understand that the director of that nursing home sought specialist help to deal with the individual with multiple pressure sores. The recommendation from the specialist was that a certain course of dressings should be sought. The nursing home approached the health board to get sanction to purchase the dressings because the patient in question was a public patient. I understand that the health board told the director of nursing that the dressings would not be cost-effective and would not sanction the funding needed.

This is an important issue. If that patient had been a private patient, the sores would have been dealt with, but because he was a public patient, they were not dealt with. This method of purchasing dressings in nursing homes is a sham. If the individual were at home in a private house, he would have had access to the correct dressings. I would like the officials to check that. That is the other story to be told here, involving the refusal of the health authority, under the control of this Government, to sanction dressings for that gentleman who appeared on television with multiple pressure sores.

This is a significant and welcome debate. It should, but probably will not, result in significant changes. This is not the first time that Members of the House have raised shortcomings in the regulation of nursing homes, but so far the Government has failed to address the concerns. With the exposure of inhuman conditions at the Leas Cross nursing home and the admission by the Taoiseach that the HSE was duped by the home's owners, it is imperative that the Government act immediately.

Nobody could have faith in a regulatory system which is so ineffective, so limited in its scope and so easily hoodwinked, yet elderly people and their families are being asked to have faith in the existing system for now rather than being given the protection in law of a properly resourced and powerful inspectorate. That is the message from the amendment of this weak and self-serving Government to this motion. It is typical of a Government that does not deal with crises in the health service, but tries to ride them out. Words of comfort from the Minister for Health and Children are no substitute for action. Apart from the Health Service Executive providing some interim arrangements at Leas Cross, the Minister has done nothing to assuage the widespread public distress being expressed.

This Government could and should introduce measures to bring this scandalous situation under control, not some time in the autumn, but now. The social services inspectorate should be put on a statutory basis, as was promised in 2001. Legislation should be introduced into the House before the end of this term. The Labour Party will be more than willing to accommodate such a measure if the Government takes up the offer.

We find it inexplicable that the Taoiseach refuses point blank to provide such protection for the elderly by way of emergency legislation. He had no problem in protecting the State from costs by having emergency legislation passed, not once but twice, in recent weeks. Nor was there any difficulty in taking swift action in 1990 when the Government recalled the Dáil to pass emergency legislation, not to safeguard vulnerable and sick people, but to save the Goodman company. What kind of priorities does this Government have that excuse such lethargy and cynicism in the face of such need?

What is the Government for, if not to protect vulnerable people from abuse and poor standards of care? A good Government would ensure legislation was fast-tracked through the House. It has the support of the Opposition and it is not as if obstacles would be put in its way. If necessary, the Government should extend this term to ensure it is introduced within weeks rather than months or even years as has been the fate of other legislation.

In the meantime, a good Government would ensure standards of safety of care. The obvious way to do this is to resource the Health and Safety Authority to carry out an audit of nursing homes immediately, as it has done successfully in our accident and emergency departments. The audit could target a number of nursing homes within a specified timeframe and report, possibly to a Dáil committee, to ensure there is transparency.

That is what good effective Government involves. Sadly, it is clear this is something we do not have.

Hear, hear.

The House will divide as it always does at 8.30 p.m., but I do not believe there is any fundamental difference of principle between the different sides of the House on this issue. There is no doubt about the shock that the broadcasting of this report has created. It is terrible that elderly persons are subjected to any abuse. We all have an obligation to ensure the highest standards are observed in our nursing homes and that any malpractice is put to an end.

This Government, like all Members, places huge value on older people and this has been reflected in many of the decisions it has taken on policy for the aged. I am talking here about the substantial increases in the non-contributory old age pension. Substantial investment has been made in this area.

Come off it.

If the Opposition wants to examine its conscience in this area, it should resile from the nonsense ——

The Government just made promises but would not even bring in the statutory inspectorate.

What was not done should be done now.

The Minister of State, without interruption.

——we had following the Supreme Court decision on the nursing home charges. Everyone knows the reality of the position and where our priorities should lie.

The Government has done nothing about it.

The Government was in power and had responsibility for the area but would not bring in the legislation.

We have an excellent social services inspectorate.

It does not inspect nursing homes.

The Deputy will have an opportunity to reply at 8.15 p.m.

It is now going to inspect nursing homes and will be put on a statutory basis under the health information and equality authority legislation.

When will the legislation be passed? It was promised five years ago.

That will be put in place. It is important that we realise that much has been done in this area. The national broadcaster should be commended on the programme shown the other night. The Government did not operate that particular nursing home and was not in charge of it. This attempt by the Opposition to turn every public issue into a direct attack on the Government is unacceptable because Government Deputies are as concerned as Opposition Deputies about the care and welfare of the elderly.

But they are not doing anything, even though they have the power. The Government will not even legislate.

It is eight years in power.

We are extending the remit of the social services inspectorate.

That was recommended in 1998.

When can we expect it?

The inspectorate does not need an Act to inspect a home. It will inspect homes from now and that will be put on a statutory basis on the enactment of the health information and equality authority.

The Taoiseach did not know that yesterday.

The inspection process is a vital need. Deputy Ryan raised this issue in the past, and all credit to him for that. Other Deputies have also raised the issue. Previously, each of the ten health board areas had discretion to adapt the procedure to suit the workings of their own inspection teams. That was provided for in the Nursing Home (Care and Welfare) Regulations of 1993. However, the inspection process is currently being updated, following the commencement of the Health Service Executive which is unifying the workings of the inspection teams nationwide.

The legislation that established the Health Service Executive was subjected to a great deal of obstruction and delay in this House, which I witnessed, by the Opposition parties.

It was obstructed because there is no democracy in it. The Government removed democracy when it abolished the health boards.

The Opposition objected to that legislation because health legislation has established an executive.

The Minister of State, Deputy Lenihan, without interruption. Deputy O'Dowd will have an opportunity to respond later.

The proof of this pudding is in the eating. Now we see what happened under the regime of the health boards. We see, thanks and credit to RTE, what exactly was happening in each health board area — no uniform standards or practice ——

We cannot raise the matter with the health boards because they are gone.

We brought in the Health Service Executive to bring uniformity to this area and to bring accountability into our health service. We were obstructed day and night by the Opposition when we sought to introduce that legislation.

That is rubbish. The obstruction is from the Government against the elderly.

The Opposition cannot just watch a programme on one night of the week and produce a motion another night. The Opposition must be as consistent as the Government. It must face up to that.

The Health Service Executive is now unifying the workings of the inspection teams nationwide. That is a welcome step and shows the value of the executive. It shows the rationale of why we need an executive. We need a body to bring uniformity into this area. The Government is committed to establishing an independent inspectorate for public, private and voluntary nursing homes. The necessary legislation is already being prepared. The policy for the inspectorate will be available this year and will examine all the shortcomings in the current legislation. It will then be easier to identify when a home does not receive the statutory minimum of two inspections within a 12 month period. It will also implement a common national standard to the inspection process.

The regulations place the requirement that designated officers should inspect a nursing home not less than once in every period of six months. This function is currently carried out by inspection teams within the HSE.

It does not carry them out.

Reports from all HSE areas were received by the Department earlier this year following inquiries regarding inspections.

Page two of the statement shows that many of the homes were not examined.

I am dealing with that issue. They revealed that in the majority of these areas, the requirement of two nursing home inspections per year is being met. Areas which were not meeting the requirement have a number of reasons for this. The two inspections may not have been carried out strictly within a 12-month period but would have been carried out shortly afterwards. Also, the statutory requirement for six-monthly inspections was being met by environmental health officers, but the requirement for twice-yearly inspections by the medical and nursing inspection teams was not being met in full in the case of all nursing homes. However, in many instances these nursing homes would be inspected more than twice a year arising from issues identified in routine inspections or where a change occurred regarding registration details. It is also the case that nurses may follow up between inspections to offer advice on nursing issues.

Last year, 435 private nursing homes were registered and needed to be inspected. Of these 82 were inspected once——

Some 82 were inspected just once.

——and would be subject to the points I already outlined. A total of 298 homes were inspected twice and 55 homes were inspected three times or more. In general, where problems occur, the inspectors from the HSE discuss the details with the nursing home operators and this generally ensures that matters are addressed. It is in this area of discussion that many concerns were raised by the Opposition. This issue will be considered in the review of the regulations. The social services inspectorate was established in April 1999, initially on an administrative basis. A commitment has been made to establish the body on a statutory basis. I fully support the proposal to establish the social services inspectorate on a statutory basis. I salute the magnificent work done by the body in inspecting children's facilities throughout the country. In the context of the health reform programme, added emphasis is being placed on setting and monitoring standards generally. The brief of the social services inspectorate will be extended to include residential services for older people. The establishment of the inspectorate on a statutory basis will strengthen its role and give it the independence it needs in the performance of its functions. It will increase public confidence in State and voluntary social services.

In line with the agreement reached yesterday by the Health Service Executive and the nursing home in question, a director of nursing from the northern area of the HSE commenced work in the nursing home today. The Minister of State, Deputy Seán Power, has received a commitment from the chief executive of the relevant HSE area that he will receive a progress report on the operation of the action plan within a month. The Minister of State also wrote to the Garda Commissioner, Noel Conroy, yesterday. He asked the Garda Commissioner to meet representatives of the HSE as a matter of urgency to discuss issues that have arisen with a view to identifying matters which should be followed up by the Garda.

Deputies expressed concern yesterday evening about the current situation at Rostrevor nursing home, which the former South Western Area Health Board attempted to close in the High Court last year. The Department, which received the most recent inspection report today, has been informed that an inspection took place on 25 May 2005. The inspection team met the person in charge and the proprietor. Another nurse was also on duty at the time. The team noted that 12 people were resident in the nursing home, which has capacity for 23 residents. A bathroom with full disabled access has been installed in the home, which is being refurbished at present. The inspection team was satisfied, when the inspection took place, that the nursing home was complying with the Nursing Home (Care and Welfare) Regulations 1993.

A great deal of work has been done in respect of nursing home regulation since the publication of the Mercer report on the financing of long-term care and the O'Shea expenditure review. The publication of the reports led to a review of legislation on nursing homes.

The Minister of State has spoken for well over the five minutes he was allocated in this slot. He is denying other Members the opportunity to speak.

The Minister of State would have been entitled to a 20-minute slot if such a slot had been available.

It is not available.

Ministers normally speak between 8.10 p.m. and 8.15 p.m. on Wednesday evenings. On this occasion, however, there is a gap as a result of the Government's failure to use all its time slots yesterday evening. Therefore, the Minister is entitled to——

The Government could not get enough speakers.

If I applied the rules in the way Deputy Sean Ryan would like me to apply them, I would have to conclude the debate at 8.20 p.m.

The House would have to vote at that stage.

It has been custom and practice——

No, Deputy, it has not.

Deputy Ryan is delaying the Minister of State.

If the Government does not use all its time, the remaining time is allocated to the Opposition.

The Opposition will have 15 minutes, between 8.15 p.m. and 8.30 p.m.

That is a change.

The Deputy should look at the clock.

The debate is organised on the basis of 20-minute slots. The Minister of State has approximately one minute remaining.

I am acting in accordance with the advice of the Chair. I am not attempting to frustrate anyone. I acknowledge that Deputy Sean Ryan has taken a particular interest in this issue and I commend him for that. I am not afraid to state on the record of the House that Deputy Ryan is one of the few Deputies who has consistently raised this issue in the House.

The amendment to the subvention regulations in 1996 gives the Health Service Executive the discretion to pay a higher rate of subvention than the rates I have mentioned, thereby further assisting people who are having difficulty in meeting the cost of long-term care. Of the more than 10,000 people who were in receipt of subvention payments at the end of December 2004, almost 4,100 were in receipt of enhanced subvention payments and a further 1,339 people were occupying contract beds. Therefore, almost 11,500 patients are receiving a contribution to the cost of their long-term care under the subvention scheme. Approximately half of them are in receipt of a payment that is higher than the rate their level of dependency may require.

The Health Service Executive has launched a national freefone information line, 1800 777737, for members of the public who have concerns about older people in residential long-term care. The information line will operate between 9 a.m. and 5.30 p.m. from Monday to Friday. The staff operating the service will take details of callers' names and concerns, and will arrange for a relevant person in the callers' local areas to contact them to follow up their queries. The HSE will vigorously pursue any complaints made about other nursing homes to ensure that the welfare of patients is protected.

Further work is required in the coming years to improve services. The active participation of all involved is needed if we are to make progress and achieve the delivery of quality and cost-effective services to older people, which is the most important aspect of this matter. The Government has given visible evidence of its commitment in this regard. It is committed to enhancing the level of support available to older people, but that can only be achieved in a sustainable and enduring manner if it is delivered in a financial environment which protects the delivery of services for the future.

The Government, which has demonstrated its commitment to developing services for older people, will continue to strive to improve their lot during its term in office. That it values the commitment of older people is clearly demonstrated by the additional resources it has allocated in recent years to improving services for them. Legislation will be introduced to ensure that the quality of long-term care settings will never again be in question.

Deputies

Hear, hear.

I wish to share time with Deputies McCormack and O'Dowd.

Is that agreed? Agreed.

I welcome the opportunity to speak on this motion. I compliment my Fine Gael colleague, Deputy O'Dowd, on the consistent hard work he has done in this area. The episode of "Prime Time" that was broadcast last Monday was harrowing and frightening. It highlighted the appalling neglect and, in effect, abuse of elderly people in our society. The core of this issue is that we do not know how widespread this problem is. The Government has failed in this regard by not putting in place a proper inspectorate. Everyone in the House is aware of some excellent and fine nursing home care facilities in the public and private sectors. We are also aware of some very poor facilities, however. I refer not just to nursing homes but to hospitals, for example. Like other Deputies, I have heard criticisms of the cleanliness of hospital facilities.

Last Monday night's television programme brought the issue of nursing home care to the fore of everyone's attention. It is important to bear in mind, however, that it is not the first time the issue has been highlighted. I do not remember when this matter was raised 21 years ago, but I heard that case mentioned on RTE radio this morning. It seems that public representatives received the same reaction on that occasion.

We do not remember that long ago.

One or two Members on the Government side might remember it.

The Minister of State should remember when it was raised two years ago.

Given that the circumstances of that time are well-documented, the Members on the other side should know about the matter, even if they do not remember it. Legislation was eventually passed at that time. If one checks the record, one will learn that regulations were drawn up, although it is obvious that they were not enforced. That is the kernel of the problem under discussion.

Given that the system in place has failed the people for long enough, I do not accept the argument made by many speakers that we need to wait for legislation to be brought before the House. The Minister of State, Deputy Brian Lenihan, and Deputy Fiona O'Malley accused the Opposition of trying to have it both ways, a charge that could be far more appropriately aimed at the Government, particularly the Minister for Health and Children, who is the leader of Deputy O'Malley's party. As Deputy Kenny said earlier, the Minister was happy to rush through legislation to legalise nursing home charges, but she is unwilling to show similar haste on this issue, despite the promises of co-operation with such legislation made by Fine Gael and the other Opposition parties. I do not like legislation to be rushed through the Oireachtas, but I would prefer that to happen on this occasion, as long as it is good legislation, rather than the House to take its summer recess while people continue to suffer. It is unacceptable for the Government to tell people to sit tight and wait for it to produce legislation after the summer.

The Minister of State, Deputy Brian Lenihan, seemed to have all the answers in his speech. If that is the case, why is the Government unable to compile the answers in legislative form and bring such a Bill to the House? There is no reason that cannot be done. The Government has been in charge of the health service for almost eight years, but it has failed to produce detailed guidelines on what nursing home inspectors should look for. Why has the Government failed to introduce uniformity across all sectors? I refer to uniformity of best practice, rather than uniformity for the sake of it. Why has it not introduced new care regulations?

Why can people not see inspectors' reports, which should be a basic matter? Why are the children of elderly parents unable to compare one nursing home with another when they are making one of the most difficult decisions they will ever have to make? I do not understand why people are not allowed to compare nursing homes, to ensure they are choosing the best possible nursing homes for their parents and relatives. We need to put in place such back-up services. Everything seems to be done after the event.

The Minister of State, Deputy Brian Lenihan, said that a great deal has been done, but that is a tired slogan. If the Minister of State was in the nursing home shown on television on Monday night, or in any other poor nursing home, he would realise there is much more to be done. Something needs to be done urgently. It is a failure on the part of the Government. The buck must stop at some door. It must stop at the door of the Minister for Health and Children.

The Fine Gael motion calls for the introduction of a uniform assessment criteria for all nursing home, and nothing could be more simple. The motion was prompted by the revelation in RTE's "Prime Time" programme on Monday night. The Government has seriously neglected the care of the elderly for years. This morning the Taoiseach made a feeble attempt to say that inspections were carried out on a regular basis. Deputy Kenny exposed the fact that just 80 out of more than 200 nursing homes were inspected in one year. Notification of these inspections was given. There was to be no notice for a second inspection, but there was no second inspection that year.

This crisis did not arise now. As far back as 1989, seven years ago, when the present Government was in power, the National Council on Aging and Older People submitted to Government a report on abuse but nothing was done about it. The Government gave a commitment to establish a social services inspectorate in An Agreed Programme for Government in 2002 but nothing was done. This morning the Taoiseach said legislation will not be introduced in this term to deal with the problem. The problems in public and private nursing homes are far more widespread than is accepted generally.

I am sure other Deputies have been made aware of many problems the elderly experience in nursing homes. There are excellent nursing homes, from which I do not want to take away, but this publicity is tarring everyone with the same brush in the way politicians are tarred with the same brush because of the actions of some unscrupulous politicians.

Hear, hear.

This gives politics a bad name in the same way this is giving nursing homes a bad name, which in some cases is not deserved.

The crux of the problem is that most elderly people do not wish to spend their final days in a nursing home. If there were proper back-up facilities for carers, fewer people would spend their latter years in nursing homes. Given their experience, elderly people in family homes could be a big asset to communities, families, children and grandchildren. If a proper carer's allowance system was put in place, there would be less need for nursing homes and it would reduce the problem with regard to nursing homes. We would have a better society, better communities and better families, but it is up to the Government to provide the necessary funds for the 110,000 carers who are caring for people in their own homes. This would encourage more people to care for their elderly relatives in their own home.

I dealt with a case this week of a lady who came home from England to mind a very sick relative. Because she was on a pension from England of €100 a week, she qualified for just €61.10 of a carer's allowance. That person is minding her family member for a miserable €61 a week for 365 days a year. If a proper carer's allowance was available to members of such families, more elderly people would remain in their own homes and we would have a better society.

The ball is in the Minister of State's court. Before he left, the Minister of State, Deputy Lenihan, read the regulations which indicated that inspections should be carried out every six months. This is what should be done. The Ministers of State, Deputies Power and Lenihan, are in Government. They should solve the problem by having inspections carried out every six months. If this is done, the second inspection will be without notice. Because inspections are carried out just once a year in less than half the nursing homes in the country, the health boards are obliged to notify the nursing homes of the inspections. This is not a real inspection, it is just examining the books. To have a real inspection, it would have to be without notice. If the Minister of State applies the criteria laid down, we will have a better society for everyone.

With the agreement of the House, I propose to call on Deputy O'Dowd to conclude the debate in the absence of Deputy Twomey who proposed the motion.

This has been an important and crucial debate in which not just Members of the House have been involved, but the whole country. I have not met anyone in recent days, either inside or outside the House, who is not talking about what went on in that nursing home. Great credit is due to the "Prime Time" programme. We need to expose these issues. We also need more transparency and openness in public life.

The Freedom of Information Act must be reformed to make it easier to obtain information, not more difficult to do so. If one tries to get a nursing home report today and it is refused, one must then submit an appeal with €75. This is not good enough. If one wants to appeal to the Information Commissioner, one must pay approximately €200. The Government is trying to prevent information on nursing homes being made available. It has also done away with democracy. There is no longer any democracy in the health service. For all their faults, under the health board system, one could raise issues with the line manager responsible for nursing homes. One cannot do so now. If one makes a phone call, it will not be returned. If one puts down a parliamentary question, one will have to wait three months for a reply, and one might not even receive a proper reply.

We need good legislation to weed out bad operators, especially since elderly patients have a high risk of suffering from an injury or abuse. Good nursing homes are paying the price for bad Government. As my colleagues on all sides of the House said, many caring and dedicated nursing home operators are tainted with the same brush as bad operators because of a lack of legislation. Everyone agrees that the independent inspectorate is vital for the nursing home sector. We have always said so. Five years ago, the Minister said in the Seanad that such an inspectorate would be set up. Over the past five years, whenever we brought the nursing home issue to the attention of the Government, we were told that something would be done, but it did not do anything. However, something will have to be done now.

The Minister of State, Deputy Callely, is in an exceptional situation. He received a letter from someone who, in the words of the Beaumont specialist, suffered from the worst case of pressure sores he ever saw in his life. He said in a letter three years later that he could still recall vividly how bad the sores were. The Minister of State did his job as a TD but he did not do his job as a Minister of State. He did not introduce legislation to change the way nursing homes operate. That is the charge against the Minister of State, which he failed to answer. He ought to resign.

The Government failed to accept responsibility for this problem. Members on the opposite benches have known about this problem for at least five years and they did nothing about it. It rests there. The Government has refused to support the Fine Gael motion, in which there is nothing objectionable. We want an independent inspectorate and an independent commission to examine elder abuse, and the Government has refused to accede to this. The Government will vote against the motion. The people will pass judgment on the Government. One of the biggest judgments they will make is in the area of the health services and the Government's failure to deliver. It is an inescapable fact that the Government knew about the issue but it refused to deal with it.

I have three questions for the Minister for Health and Children. Will she publish a recent eastern health area report in respect of nursing homes? Did any group of doctors recently recommend to the High Court that the Leas Cross nursing home in Swords was suitable for patients? Did the Minister carry out any assessment of nursing homes before patients are transferred there arising from the accident and emergency package?

Does the Deputy expect to get answers?

It is a fact that the Minister of State put people into nursing homes. The question is whether there were adverse medical reports on these nursing homes.

Everyone wants things to be right and to change. There is no reason the Dáil cannot sit next week. There are models for legislation in England, which is one of the best in the world, New Zealand, Canada and America. There should be no difficulty structuring legislation in this regard but the Government has neither the will nor the intention to do it. People continue to be put at risk in nursing homes.

A local chip shop can be closed if it breaches hygiene regulations but the Minister of State cannot close the Leas Cross or Rostrevor nursing homes because the High Court has ruled he does not have the power to do so. That will continue until the law is amended and the Government should do so now.

Where is the Tánaiste and Minister for Health and Children?

Amendment put.
The Dáil divided: Tá, 69; Níl, 52.

  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Cooper-Flynn, Beverley.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cullen, Martin.
  • Davern, Noel.
  • de Valera, Síle.
  • Dempsey, Tony.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDowell, Michael.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M.J.
  • Ó Cuív, Éamon.
  • O’Connor, Charlie.
  • O’Donnell, Liz.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Ned.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Treacy, Noel.
  • Wallace, Dan.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.

Níl

  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burton, Joan.
  • Connaughton, Paul.
  • Costello, Joe.
  • Crawford, Seymour.
  • Cuffe, Ciarán.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • Ferris, Martin.
  • Gregory, Tony.
  • Harkin, Marian.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • McCormack, Padraic.
  • McEntee, Shane.
  • McGrath, Finian.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Mitchell, Gay.
  • Mitchell, Olivia.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided by electronic means.

As a teller, under Standing Order 69 I propose that the vote be taken by other than electronic means.

As Deputy Kehoe is a Whip, under Standing Order 69 he is entitled to call a vote through the lobby.

Question again put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 67; Níl, 53

  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cullen, Martin.
  • Davern, Noel.
  • de Valera, Síle.
  • Dempsey, Tony.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDowell, Michael.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M.J.
  • Ó Cuív, Éamon.
  • O’Connor, Charlie.
  • O’Donnell, Liz.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Ned.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Treacy, Noel.
  • Wallace, Dan.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.

Níl

  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burton, Joan.
  • Connaughton, Paul.
  • Costello, Joe.
  • Crawford, Seymour.
  • Cuffe, Ciarán.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • Ferris, Martin.
  • Gregory, Tony.
  • Harkin, Marian.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • McCormack, Padraic.
  • McEntee, Shane.
  • McGrath, Finian.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Mitchell, Gay.
  • Mitchell, Olivia.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Question declared carried.
Barr
Roinn