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Dáil Éireann díospóireacht -
Wednesday, 22 Jun 2005

Vol. 604 No. 5

Leaders’ Questions.

As the country's elderly population grows, it is critical to have a nursing home sector in which people have confidence and where the highest standards apply and are seen to apply. It is the responsibility of Government to ensure the law and the inspectorate regime in place are also of the highest standard to ensure that this happens. The Leas Cross affair, as exposed by Deputy O'Dowd and the "Prime Time" programme on RTE, has severely dented people's confidence in the Government's ability to ensure the highest standards in our nursing homes.

Yesterday the Taoiseach confirmed that a critical report on Leas Cross was submitted to the health authorities last autumn. He said it was very critical and raised serious issues. I have four questions for the Taoiseach in that regard. Why was so little done about the appalling level of care provided in Leas Cross until the "Prime Time" programme forced the Government to act? Second, why did the Taoiseach, on 1 June this year, tell the Dáil that the inspection regime was not the problem in Leas Cross when this report apparently flagged the fact, eight to ten months ago, that a serious situation had arisen there?

Third, why was Leas Cross management given advance warnings of inspections even though the authorities had such a critical report in their possession? The authorities were aware of the seriousness of the situation yet they continued to inform Leas Cross of when inspections would take place. Fourth, why has the Government failed to act on a solemn promise the Taoiseach gave four years ago to initiate a new inspectorate for nursing homes? The sad fact is that inspections took place but these were notified and were inadequate. The Government failed to act and has severely dented the confidence of elderly people and the public in this matter.

First, I wish to acknowledge the upset of the family of the late Peter McKenna, whose death prompted the issues we discussed here yesterday. His brother and sister have spoken movingly about his final days. Any family would rightly be upset, as would I and any Member of the House. I did not acknowledge that fact yesterday. Clearly, the delay in finalising the report about his death and the delay in acting on it is not satisfactory for me or the Tánaiste. It demonstrates again that the system previously in place did not meet the needs of vulnerable patients. I accept there are 20,000 people in both private and public nursing homes but the point is that there must be standards that are adequate in every case. It is not a system people can stand over.

As the Tánaiste said yesterday, we will publish this report after it has gone through the necessary due process. It must go through this process to take account of the legal consideration that people mentioned in the report have a right to see the report. The Government is bringing forward the social services health inspectorate legislation which will deal with these issues.

With regard to whether these reports were brought to Government, I do not have blow by blow details. When there is a report by a health board or the Health Service Executive about a case, people think that every such report and examination is brought to the Government. It is not. As I understand it, in this case complaints were made or concerns were expressed — I do not know how it happened — in August 2003. The health board that was responsible for Leas Cross at the time initiated an examination in autumn 2003. Somewhere along it way it moved from being an examination of the Peter McKenna case to an examination of the inspectorate of the health board. I have never seen the report but I understand it is mainly about the Peter McKenna case but also discusses some issues regarding the health board.

I am subject to correction but my information is that from autumn 2003 to the first week of this month, which was after I answered questions in the House, that report was not completed. It was completed subsequent to me speaking in the House on 1 June. I believe it was finalised around 8 June.

With regard to standards for the future, the objective is to try to achieve proper standards for everybody. There are 20,000 people involved and, hopefully, the vast majority of them are extremely happy but in cases where it is otherwise, the social services inspectorate legislation will deal with it. We have invested enormous resources and staff to ensure these matters are dealt with properly. We will continue to do that to ensure we have the best standards in the future.

The problem is that people view the Government as not taking any action on foot of the information it is given. There were five complaints about Leas Cross since December 2003 but nothing was done. The Minister of State, Deputy Callely, was informed of a serious case, in a different nursing home, where the consultant described the bedsores as the worst he had ever seen. The Taoiseach said on 1 June that the strongest inspectorate, because it is a dedicated unit, is in the former Northern Area Health Board where Leas Cross is located. If that is the strongest inspectorate, and given the consequences of that kind of inspection, notified or not, is the Taoiseach satisfied the inspectorate regime for other nursing homes throughout the country is sufficiently clear for action to be taken? When the consultant submitted his report did the Tánaiste, in her capacity as Minister for Health and Children, call in the official who received that report, in respect of which no action was taken? Irrespective of whether it was a draft or final report but given the explosive nature of its content, why was no action taken between receipt of the report and the broadcast of "Prime Time", when all hell broke loose?

When does the Taoiseach expect the report to be published or is it being held up by management in the Leas Cross nursing home? This is of considerable interest not just to the relatives of the patients involved but to the entire population. It no longer has any confidence in the Government because there is no leadership and nobody on the Government side seems to care about what is happening.

It is time for the Taoiseach to move over.

The Deputy has asked several questions which I will try to answer quickly. The parties to the report have until 6 July to give their views. They include the family, the doctors and the members of the board in this case. I have already given the facts about the report.

I should have said that, as I understand the matter, the Department of Health and Children wrote to the then Eastern Health Board at an early stage. I dated the sequence of events from autumn 2003 but the case arose far earlier. In autumn 2000 the man died and the Department of Health and Children wrote to the then Eastern Regional Health Authority in autumn 2001, following the first representation about the case, but finalisation of the report was impeded due to lack of access to the medical records because the deceased was a ward of court. The High Court approval for access did not come through until August 2003. That is what happened in the intervening years. The process did not start until 2003 for those reasons.

The Deputy asked whether we can be satisfied the process was good enough, given that Leas Cross was in the former Northern Area Health Board which was considered to be the best area. Of course we are not satisfied. I have acknowledged that before. This was not good enough, although the Northern Area Health Board considered its inspectorate standards were of a high order. We cannot consider it was good enough. The Tánaiste expects that Professor Drumm, and the new legislation which she will present to the House on the social services inspectorate, will ensure we reach the highest standards.

The Tánaiste has brought the question of why no action was taken to the highest level in the then health board. The report begun in August 2003 was not to my knowledge or that of anyone else brought to the Government's attention. I am not playing the blame game but the report was not brought to our attention. Only when it was suggested in the House that I look at the McKenna case did I become aware there was any report. That report was not completed until 8 June. The Government did not know about any report and could not have known about it as there was none until after the television programme was broadcast. Those are the facts.

That is a very poor excuse.

The Minister of State, Deputy Callely did not tell anyone about it. He kept it a secret.

Since the publication of the second Morris report on events in Donegal we have tried to get the Government to honour the report's one major recommendation, namely, to review the Garda Síochána Bill.

The Minister for Justice, Equality and Law Reform has adamantly and arrogantly refused to do as Mr. Justice Morris recommended. He has taken the position that he knows best. The man who was the greatest critic of the "nanny state" turns out to be the biggest nanny of them all. According to what we hear on the radio we have extracted amendments from the Minister that will hopefully improve the Bill but do not meet the requirements set out in the Morris report.

Regardless of what the Minister is saying to the Taoiseach, will the Taoiseach please concentrate on this matter for a second? The published list of amendments concerns pages 1 to 18 of the Bill. The Bill is 92 pages long. The Minister has published the amendments to page 18 — he should not behave like a schoolboy now, showing his homework to the master——

It is unfinished homework.

It is very late homework.

There are amendments to page 18.

Deputy Rabbitte is the boy who left his satchel at home.

It is a change from being a bully boy in the school yard.

There are 92 pages in the Bill and now facsimile machines are beginning to spurt white pages in no order, one here, one there, and the large amendments the Minister announced on radio have not yet been published. We are being asked to debate Report and Final Stages of this Bill without even having seen the amendments. This is the way the man who so often lectured us is treating this House and legislation on such an important matter.

Why does the Taoiseach propose that this House should adjourn on 1 July? This is unprecedented in my memory. We would have plenty of time then to give this serious Bill the attention Mr. Justice Morris said it requires. What possible excuse is there for adjourning this House on 1 July, except that the Taoiseach and his Government want to escape this Chamber?

I want to ask two questions of which I have given the Taoiseach prior notice. Did the Minister for Justice, Equality and Law Reform seek the removal of the Garda Commissioner following the second Morris report?

That is an outrageous allegation. There is no substance in it. The Deputy has no principles.

The Minister is not involved in this question. Leaders' questions are directed to the Taoiseach.

I did not make any allegation. I asked a question and I am very interested in the impact it has on the Minister.

It is like the question "When did you stop beating your wife?". That is an outrageous allegation.

The Minister should allow Deputy Rabbitte to continue asking his question.

The Ceann Comhairle should throw the Minister out of the House.

Has the Taoiseach received a note since yesterday on whether the current Minister for Justice, Equality and Law Reform, Deputy McDowell or his predecessor, Deputy O'Donoghue, told an untruth to the House? Deputy McDowell said he had not received the Carty report, which got him off the hook in terms of the advice he gave Deputy O'Donoghue, and gave him justification to resist the inquiry. Deputy O'Donoghue unfortunately told Deputy Howlin a year earlier that he had received the Carty report. Has the Taoiseach established which of them was telling an untruth to this House?

Deputy Rabbitte has asked three questions. We have now published all the amendments in full. They are all here, completed and before the House. That is in line with what we were asked to do. We were advised to wait until the debate before publishing the final amendments.

There is a guillotine on the Bill for tomorrow.

We have done as we were asked: the debate was held last week, the second Morris report was published the previous week and the Minister has taken both of these into account. We have a long debate on the Garda Síochána Bill. The heads of the Bill were published and a consultation process was initiated.

The heads of the Bill were published two years ago.

We received and examined a report from the Human Rights Commission. We had a lengthy debate in the Seanad. We had one of the longest Second Stage debates in the history of the Dáil, followed by an extensive Committee Stage debate. The Opposition asked that the two Morris reports be debated before Report Stage. We have done all of those things and the debate is about to conclude.

The amendments set out a new statutory duty to account for members of the Garda Síochána. The Minister has listened at length and conducted a detailed review of all the issues. I can go through the amendments, but I presume it is not necessary with only two minutes to do so. However, they set out to strengthen the Bill's provisions regarding the system of promotions for gardaí and the change in methods of appointment for the new Garda audit committee. They also strengthen the Bill's existing provisions regarding the accountability of the Garda Commissioner, make clear the Commissioner is fully accountable to the Minister, strengthen the Bill's existing provisions obliging the Garda Commissioner to supply the Minister with information of significance relating to policing, and the list goes on, including not only significant issues raised in the Morris report but those the Minister identified through his own consultation and review.

On yesterday's question, I read what the former Minister for Justice, Equality and Law Reform, Deputy O'Donoghue, and the current Minister, Deputy McDowell, said last week, which I had not done yesterday. The latter outlined the sequence of events regarding the furnishing of information by the gardaí during Friday's debate. He made clear that the then Minister for Justice, Equality and Law Reform, Deputy O'Donoghue, behaved impeccably throughout. The Garda Commissioner appointed Assistant Commissioner Carty to examine the handling of the original investigation carried out into the death of Richard Barron. The Assistant Commissioner completed his investigation, which turned out to be extremely complex. He forwarded the file to the DPP for consideration of criminal charges against individual members of the Garda. In August 2000, the then Deputy Commissioner, Mr. Noel Conroy, forwarded to the Department of Justice, Equality and Law Reform a summary of Assistant Commissioner Carty's report. It was clearly felt that, as the Minister pointed out on Friday, no doubt in good faith, it would not be appropriate to forward the full report, as it was central to a criminal case.

The former Minister, Deputy O'Donoghue, pointed out in a series of oral parliamentary questions during 2000 and 2001 which he showed me overnight that he had received a report of the investigation from the Garda Deputy Commissioner — not the Carty report, which was the point that Deputy Rabbitte was making yesterday — and had serious concerns about the behaviour of the gardaí in Donegal. In the context of determining what action was appropriate on foot of those serious concerns, the Attorney General repeatedly requested sight of the Carty report, as did the Minister. There was therefore no contradiction in what the two Ministers said last week.

There was a total contradiction.

There was none whatsoever.

The report was not provided to the Attorney General or the Minister for Justice, Equality and Law Reform by the Garda authorities at that stage on the basis of pending criminal cases. A partial version of the Carty report was eventually furnished in November 2001, the same month in which Shane Murphy, Senior Counsel, was appointed to review the matter. The complete Carty report, as was stated last week, including appendices, was not furnished to the Minister or the Attorney General until the very end of January or early February 2002. The point that Deputy Rabbitte made yesterday therefore falls.

What about the further advice?

Allow Deputy Rabbitte without interruption.

Just in case Deputy Rabbitte comes back, there was no truth whatsoever — not a shred — in the allegation that the Minister had called for the resignation of the Commissioner.

The Taoiseach and Ceann Comhairle will recall a date in 1989 or 1990 when a predecessor of the former told the House that "no such meeting" had taken place. Now the Taoiseach is engaging in the same sort of semantic blather regarding the Carty report. The question from Deputy Howlin was whether the Minister had received the Carty report and what he proposed to do with it. The Minister led him to believe that he had received it and that, as a result of it apparently not bearing out the allegations made, he felt justified in shooting down any investigation, which was the advice from the then Attorney General.

It is entirely a matter of semantics whether it was a summary of the report or the report itself. What the Minister for Justice, Equality and Law Reform has said is that it was the report minus the appendices, which would have been the witnesses' statements. Regardless of whether it was a summary, partial, or full, Assistant Commissioner Carty's report would have borne out the gravamen of the allegations in Donegal. There is no doubt that it would have borne it out.

The Deputy's time is concluded.

Yet the Minister shot it down. Regarding the long consultation on the Bill and its heads, the debate in the Seanad and the Human Rights Commission, all that had been done when Mr. Justice Morris drew his conclusions, and is nonsense and irrelevant. Mr. Justice Morris was looking at the Bill after that entire process had been completed, and he said it was inadequate and needed to be reviewed. Given the manner of production of last-minute amendments, some of which we have not even seen yet, there will be no opportunity for this House to scrutinise them and no opportunity for a proper debate. It is all on Report and Final Stages, which is a disgraceful way to deal with legislation, to treat this House and Mr. Justice Frederick Morris——

The Deputy's time is concluded.

It is a disgraceful way to treat the Garda Síochána and a disgraceful attempt by the Minister, Deputy McDowell, and his predecessor, Deputy O'Donoghue, to blame the Garda authorities for not giving them the Carty report when in fact Mr. Noel Conroy had given them its essence. They both had it and colluded to cover it up in this House as an excuse for not conceding an inquiry.

The Deputy's time is concluded.

Those are wild allegations.

Everything is "wild".

Deputy Rabbitte knows that is entirely untrue.

The Carty report was not given until late January or early February 2002.

Publish what was given.

I am answering Deputy Howlin's leader. He has had plenty of time to talk about these issues.

The Carty investigation and its distillation, as the Minister has said on the record several times, was done by the then Deputy Commissioner Conroy. It was not done by Mr. Carty, and it was not even the Carty report.

What has that got to do with it?

The Attorney General stated many times to the Minister, and put the point forward himself, that he could not act until he had the full report. When that full report was prepared, both he and the Minister acted.

They told me that he was screaming for it.

Deputy Howlin, please allow the Taoiseach without interruption.

It is entirely false to get a few dates and try to cobble something of that sort together when the Minister has made matters absolutely clear. To try to say the Minister is doing anything other than being entirely supportive of the Garda Síochána by introducing a modern Garda Síochána Bill, having gone through a detailed process and taken account of the issues with which the public, Mr. Justice Morris and this House are concerned in a lengthy debate is fatuous. The criticism is because, having listened to all that, he should have come forward.

Deputy Rabbitte has called the Minister arrogant. If he had not listened to any of the debate and gone through the entire process, introducing amendments beforehand, the Deputy could have said that about the Minister. However, he has waited, listened and had one of the longest debates in the history of the State before bringing forward amendments; yet he is still being described as arrogant. That is an entirely unreasonable approach.

I call Deputy Sargent.

What about the amendments on Report Stage?

The Taoiseach knows there are 44 pages of amendments.

(Interruptions).

Please allow Deputy Sargent without interruption.

Perhaps I might ask the Ceann Comhairle if he has received a letter from me regarding time on Leaders' Questions. I would like to discuss it with him later.

I have received a letter from the Deputy and brought it to the attention of the other leaders. For the benefit of the House, we are now almost 11 minutes over time.

We obviously have work to do.

Perhaps I might ask the Taoiseach about the reply that he gave on 20 April in which he claimed hospital facilities were excellent once one had got through the accident and emergency department. Will he correct the record in that regard, especially concerning people vulnerable to infection and in particular people with cystic fibrosis, who would not have to go near an accident and emergency department or hospital if more specialist cystic fibrosis centres were in place? I know the Tánaiste and Minister for Health and Children, Deputy Harney, has seen Dr. Ronnie Pollock's report, which was carried out for the Cystic Fibrosis Association of Ireland.

Apart from catching up quickly with a word in his ear from the Tánaiste, has the Taoiseach had a chance to evaluate the report's recommendations? Is he as aware as he should be that Ireland has the highest incidence of cystic fibrosis in the world? On average, a person with cystic fibrosis dies almost ten years earlier in Ireland — in his or her early 20s — than a person with the disease in the North or anywhere else. In the US, a person would on average live into his or her 40s, and much older in some cases. Will the Taoiseach increase the €300,000 the Tánaiste is giving to St. Vincent's Hospital, which treats 60% of adult cystic fibrosis patients, given the dangerously low level of services and facilities because of lack of funding? As a tangible way for the Taoiseach to help matters, will he indicate whether he will lift the cap on staff recruitment, which means the hospital cannot even recruit permanent staff with that paltry sum? It needs an additional €8 million to provide adequate services for cystic fibrosis patients. Will the Taoiseach at least indicate that he will lift the cap so that permanent staff can be recruited in the interim before the money is made available?

The Deputy knows the point I made. I said that accident and emergency facilities are under pressure for several reasons. However, the public constantly expresses satisfaction with the services it receives, whether as inpatients or outpatients, in theatres and in specialist services, in regard to maternity services, cardiac surgery and so on. International statistics indicate that these services are better than anywhere in the world and we should be proud of that.

I asked about cystic fibrosis.

The point I made is that we have achieved enormous success in a range of health services.

The Tánaiste dealt with the issue of cystic fibrosis during yesterday's Question Time and has met the people concerned, as the Deputy mentioned. St. Vincent's Hospital is the national centre for cystic fibrosis patients and we have put significant resources into the process that is under way to upgrade the service and provide additional staff. More than €300 million has been spent on the new hospital that is about to open in Elm Park. As part of a €600 million programme for the health service nationally, the Tánaiste last night announced an additional €42 million for the fit-out of St. Vincent's Hospital.

Treatment of cystic fibrosis patients is one of the high-level services the hospital provides. I hope the additional resources and staff and the ongoing process of updating the facilities will improve the delivery of this service, one of many provided at this excellent hospital.

The Taoiseach has given a good illustration of the reason we must reform the procedures in this House. He does not answer the questions put to him and that is the case in regard to the question I asked about the resources needed for staffing at St. Vincent's Hospital. He did not even mention the cap on recruitment, the one specific point on which I requested a response apart from the general questions I put. I ask him again to address the minor consideration of allowing for the recruitment of permanent staff, even though the paltry funding of €300,000 is far short of the €8 million the hospital requires to provide these services. If he were to deal even with this matter, it would be some small progress.

Does the Taoiseach recognise, despite all his claims that this state is the best and provides a wonderful service, that Ireland is a disgrace internationally in this area? We are the worst in the world in terms of mortality from cystic fibrosis. A staffing level of 175 is required but only 40 are provided and 3.3 consultants are appointed when 29 are needed. The estimated cost of providing the service is €9 million annually. The amount spent on cystic fibrosis is approximately the same as the overrun in the Department of Justice, Equality and Law Reform, money that is wasted. Can we save some of that money and give it to those who need it, those who, because of Government policy, are dying an average of ten years' earlier than sufferers in other parts of the world?

The Deputy has asked me to answer one particular question and I will do so. We are recruiting additional staff.

Will they be permanent staff?

We are aware that additional staff is required in this area and the Tánaiste has given resources for that. More consultant staff are required for many of our specialist services. We have significantly increased the number of staff in the health service to more than 106,000 people and we will continue to do so. The provision of services for cystic fibrosis patients is an important area. I am not arguing that we do not need to improve the service. However, I object to the constant attempts to talk down the 106,000 people who provide a good service.

I am not trying to talk down anyone. I am concerned that Ireland should reach international standards in this area.

The Taoiseach should be allowed to continue without interruption.

We are talking down the Taoiseach and his Ministers.

Our standards are internationally recognised. Our consultants and medics are considered internationally to be of a very high order. The Deputy and his colleagues seem daily to find an issue somewhere around the country about which they can complain. These people are out doing their best——

We are talking about cystic fibrosis.

The Taoiseach should be allowed to speak without interruption.

We acknowledge the improvements that are required and it is the reason we have put an additional €1 billion per year into the health service.

Patients still cannot get a bed.

It is the reason the Tánaiste last night announced an extended capital programme of more than €600 million that will improve the health service throughout the State.

Does the Taoiseach believe that is enough?

That should be acknowledged in this House now and again.

That is unacceptable. The Taoiseach simply does not care about this matter.

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