Vol. 620 No. 6
6 Mr. Gormley asked the Tánaiste and Minister for Health and Children the reason for the delays in introducing legislation for an independent inspectorate for nursing homes; and if she will make a statement on the matter. [21291/06]
9 Mr. S. Ryan asked the Tánaiste and Minister for Health and Children her views on the fact that a full year after it was proposed, the new watchdog to enforce proper standards of care for the elderly is still not in place; when same will be in place; and if she will make a statement on the matter. [21311/06]
77 Mr. P. McGrath asked the Tánaiste and Minister for Health and Children the reason for the delay in introducing an independent nursing home inspectorate as promised since 2001; and if she will make a statement on the matter. [21266/06]
The inspection of private nursing homes is the responsibility of the Health Service Executive under the Health (Nursing Homes) Act 1990. The 1990 Act provides for the registration of private nursing homes and for procedures for attaching conditions to the registration and de-registration of nursing homes.
The Nursing Homes (Care and Welfare) Regulations 1993 set out the standards to which private nursing home owners must adhere in the provision of nursing home services. In accordance with the regulations, the HSE carries out inspections of private nursing homes. The HSE has inspection teams in each area and those teams are composed of a chairperson who is usually the senior medical officer, a director or assistant director of public health nursing, and a principal or senior environmental health officer.
Following inspection each nursing home receives an integrated report which contains recommendations on best practice conditions which are required for continued registration. Under the 1990 Act and the 1993 regulations, the HSE can attach particular conditions to registration. The inspection team liaises with the proprietor to ensure compliance with the regulations within an agreed timescale. The type of breaches that are identified during inspection by the HSE include contracts of care with relevance to the detail of fees and updating of same, hygiene levels, undertaking regular fire drills and the maintenance of firefighting equipment, accident prevention policies, accuracy of staff rotas-records maintenance systems and appropriate stimulation and entertainment activities for clients. Two inspections per year of every nursing home are required in accordance with Article 24 of the regulations. In addition, the inspection teams carry out follow-up inspections, as required, and conduct advice visits for prospective nursing homes.
A nursing homes inspection and registration working group was established in July last by the HSE and its report made a number of recommendations in specific priority areas in regard to nursing home inspections. The working group is confident the implementation of these recommendations will be the first test towards bringing consistency to the whole area of nursing home inspections and registrations, with new standardised processes being put in place and the appointments of dedicated inspection teams whose remit solely covers all aspects of nursing home inspections, registration and investigation of complaints.
A training programme is also being developed for the HSE nursing home inspection team. The HSE has advised that mandatory inspections will be unannounced and follow-up inspections may be announced or unannounced. The HSE is committed to publishing inspection reports on nursing homes and these are expected to be published from mid-July onwards.
I very much welcome the Tánaiste's reply to this question and an earlier Priority Question in regard to the publication of nursing home reports in July. The Information Commissioner was given an undertaking by the HSE last year, following the 2004 report, that such information would be made available on the Internet but this was later withdrawn. I seek clarification from the Tánaiste that the information on inspections will be available on the Internet, subject to the deletion of people's names. I appreciate that less information may be provided on the Internet than would be made available in response to a private inquiry. Will the Tánaiste clarify whether it is her intention that the information would be published on the Internet so that public representatives, family members and the public can check on the inspection of individual centres?
Notwithstanding this relatively positive news, will the Tánaiste acknowledge that there is still some element of disarray in terms of nursing home inspections in that the checking of nursing home inspection reports is not standard prior to the placing of clients in specific nursing homes? No matter what one does to make the system more transparent or independent, if a nursing home is shown to be deficient in certain areas and it remains open, would it not make sense, either through an amendment to legislation such as the Health (Nursing Homes) Act 1990 or even through the introduction of guidelines, to make it mandatory for the HSE to check nursing home inspection reports prior to placement? This would improve public confidence in nursing homes.
The intention is to publish the inspection reports from mid-July. I am not certain what form the publication will take. I will discuss that with the HSE but it would be common practice to have it on the Internet. I will certainly ensure that happens because it is more convenient from the point of view of families and the public and the perspective of the HSE.
When the HSE purchases nursing home places, the inspection record is crucial in that regard. It is important, in the context of making agreements with nursing homes to take particular patients for a period of time, that regard is taken of the standard of the nursing home. Last year, beds were offered that were not procured because of the results of previous inspections. I accept that we need to strengthen the law in this area. I dealt with that issue in reply to earlier questions.
Will it be in the legislation?
Yes. As a matter of routine, when somebody is inquiring about a nursing home or seeking to place a relative in a nursing home, he or she should be able to find out the track record of that nursing home and, clearly, publication of the inspection reports would greatly assist that. We must also increase the standards and make sure they are monitored on a consistent and thorough basis.
In response to an earlier question the Tánaiste outlined the theory of the situation but the reality is clearly different. While I welcome the provision in the legislation to provide for the inspectorate, I am disappointed it has taken so long. Even with the inadequacies of the existing system the Department indicated it was satisfied that, in the event of the health and safety of older people being at risk, the HSE inspectors currently have the authority to protect the older people involved. That was not the case in regard to Leas Cross.
In future, will the requirement for two inspections a year be met and will the inspections be sufficiently broad to provide information on quality of life issues? I concur with the recent report from the National Council on Ageing and Older People. Beds alone are insufficient, quality of life issues in nursing homes are equally important. Reporting arrangements under the current system are totally inadequate. Will it be a requirement that all reports would be automatically made public? Perhaps there should be a greater requirement for inspectors to report directly to the Oireachtas or a committee of it so as to provide transparency in everything that is done.
The inspectors will have powers to inspect on a frequent basis. Currently the rule is that each home should be inspected twice. I am not certain we should focus on the number of inspections per year. It may well be the case that some nursing homes require more frequent inspections than others and those which operate to a high standard may only require an inspection once every year or 18 months. It is important that the inspections are unannounced as it makes people more robust and thorough.
In addition, I will make provision for a whistleblower's facility in the new legislation. I hope that will encourage staff or family members of loved ones who are in nursing homes, or others, to bring matters to the attention of the authorities if they see something inappropriate happening.
I have visited hundreds of nursing homes in recent years, particularly in the past two years. To be fair, the vast majority of them operate to a high standard. I have gone to nursing homes where the level of stimulation and activities is fantastic and they are very happy places. However, I have gone to other places and wondered about them.
In fairness to the public sector, we will have a significant amount of work to do to adapt our public institutions to what I would call more appropriate modern conditions. As Members are aware, many of them are very old buildings that were former workhouses. Some of them have long wards where large numbers of patients are accommodated. In one case there was not even room for a wardrobe between the beds because space was so confined. That is not acceptable. We have made provision in the capital programme for funding to be supplied to the nursing home in question. As we provide funding to modernise some of these facilities this will probably result in a reduction in the number of beds to create more space. We have a long way to go but we are on the road, in particular to providing more resources, legislation and services for older people, in nursing homes and in the home and community.
The quality of the replies and additional information we have received in the past hour is almost as dismal as the Government's handling of the issues raised. The replies we received today were absolutely diabolical. The only thing I learned is the astounding fact that the Tánaiste has visited nursing homes about which she has concerns. Deputy Seán Ryan asked the Tánaiste to tell him what happens in respect of elderly people and their entitlements to nursing home care paid for by the State and whether public nursing home beds are available to them. A question I have asked at least six times either in this House or in meetings of the Oireachtas Committee on Health and Children concerns whether the Government has examined the statutory entitlements of patients over 70 to free public or private nursing home care. If it transpires that people in this group have a statutory entitlement to nursing home care, it will make the illegal nursing home charges look like loose change.
The Tánaiste appears to have avoided giving a direct answer to this question time after time. Given that it was raised by Deputy Seán Ryan, it might do no harm for the Tánaiste to put the Government's opinion on this issue on the record of the House. Is this another problem that is brewing and will Deputies present in this House in 2009 hear Ministers claim that this issue was never raised with them? A serious problem exists in this area, which has not been addressed by the Tánaiste, even when questions were raised about it.
I am sorry Deputy Twomey is in such bad form today. He is in an angry mood and has alleged that replies are abysmal. I am not inventing policy as I go along. A considerable amount of work has been carried out in respect of care of the elderly. One of the most senior, respected and experienced officials in my Department has responsibility for this area, work which has been under way in my Department for some time. I am not playing politics. I acknowledge the existence of a major legislative deficit in many respects, both in respect of inspection and nursing home regulations, which we discussed before Question Time commenced. Proposals concerning the issues surrounding long-term care are before the Cabinet because there is a lack of clarity in this area.
In respect of eligibility for services, Deputy Twomey is aware that some issues concerning private nursing homes versus public beds are being tested in the courts. Deputy Twomey will accept that it is not possible or affordable for the State to provide fully funded nursing home care to every citizen who reaches the age of 65.
That was not the subject of my question.
The law concerning eligibility has not been changed since the early 1970s. As the Deputy is aware, the Government is working on eligibility and entitlement legislation, which will clarify which individuals are entitled to which services because greater clarity is needed in this area.
The Tánaiste is again avoiding the issue. The Health (Miscellaneous Provisions) Act 2001 gave everyone over 70 a statutory entitlement to inpatient care. I am not asking the Tánaiste to tell me how much it will cost or whether it can be provided. I am merely asking whether we are exposed to significant costs going into the future and what the Tánaiste's thoughts on the matter are? She is skirting the issue. We should forget about the courts because we are not answerable to them. The events of last week have shown us that we do not have to wait for them to make their decision. We should try to pre-empt the outcome and deal with it. Can the Tánaiste clearly tell the House whether a problem exists and whether we will end up changing the 2001 legislation if we wish to incur savings? Can she tell us whether everyone over 70 has a statutory entitlement to free public or private nursing home care?
I am not skirting any issue. The issue of whether everyone over 70 is entitled to a bed funded by the State and if a bed in a public facility is not available, whether the State must fund a bed in a private nursing home is being tested in the courts. As we know from the 29-year-old issue concerning charges, no legislation we introduced could be retrospective. I do not know how this will be determined.
We must decide what individuals are entitled to, both in terms of inpatient and primary care services and other services. Deputy Twomey is aware that the issue of the long-term illness card frequently arises. I understand Deputy Twomey has asked me about this scheme during meetings of the Oireachtas Committee on Health and Children. No new disease or condition has been added to this scheme since 1978, chiefly because of the cost involved in adding them and the entitlements which flow on foot of it. Clearly, it is not acceptable to preside over a scheme which has effectively been frozen since 1978. All these areas, including services to which the medical card and long-term illness card entitles people, the question of whether these schemes should be married together, the hospital services to which people are entitled and who might make a contribution and when must be the subject of separate legislation. Until we have this legislation, we will not achieve clarity in this area. This legislation will not be ready for a number of months because it is a mammoth and very complex task.
This issue affects elderly patients whose care costs at least €60,000 or €70,000 each year. It will also have a significant effect on taxpayers going into the future. It is akin to the case in which it emerged that the former Minister for Health and Children, Deputy Martin, did not read his brief. The Tánaiste needs to give us a definitive legal opinion. I acknowledge that she is right about the retrospective element of this but if a problem exists, it should be dealt with now. Otherwise, she should be quite honest with the people of Ireland. A considerable number of people who visit our clinics are paying for their nursing home care. The Tánaiste has not given a definite answer to my question.
I informed Deputy Twomey that this is being challenged in the courts.
It does not matter what the courts do.
It is unreasonable and unsustainable to stipulate that everyone is entitled to everything, regardless of their resources and family circumstances. If such a system were sustainable and the courts ruled in its favour, we would be forced to legislate in that area because it is not affordable. It is unfair that very wealthy people would be entitled to the same level of services as people who are not well off or quite poor. The case involving public nursing home care and beds in private nursing homes is being tested in the courts. The question of which health services to which people are entitled will be the subject of separate legislation known as the eligibility and entitlement legislation. We must decide which individuals are entitled to which services and, until we obtain clarity in this regard, confusion will exist.
Will it be introduced before the court judgment?
That is separate legislation which is under way and has been committed to for some time. It is a major task.
Does the Tánaiste agree with the National Economic and Social Forum when it argued that for many older people, inappropriate or unnecessary admission to acute or long-stay residential care could have been avoided or, at least, delayed by the greater development of community-based services and the use of preventative and proactive approaches? Does she accept that, as well as the stricter standards which are clearly required in nursing homes, we need more emphasis on real and effective community care for older people and that this care in the community must have the same stringent standards applied to it as those which apply to residential care? The Tánaiste previously mentioned the importance of the community care approach. It is one thing to make broad brush statements but what is the working of the Department's policy pursuit?
Why, once again, has the commitment to provide a day care centre in Cootehill in County Cavan been placed on an ever-lengthening finger? Senior citizens in this town have long been promised this facility and I have continually raised this issue with the Tánaiste and the Minister of State, Deputy Seán Power. The Health Service Executive, HSE, is now reneging on the level of HSE-funded staffing and resources which had previously been signalled and committed to. Why is this scenario continually repeated and why are proposed dates for the commencement of this service continually put back? Many of those who have spearheaded the demand for this centre in Cootehill will never live to enjoy it. This is the reality. What is the Tánaiste's response?
In respect of Deputy Ó Caoláin's earlier intervention, the same standards must apply wherever older people reside, irrespective of whether it is in a public or private facility. Deputy Twomey said that I saw terrible standards in facilities I visited but I saw no terrible standards of care anywhere. The standards of care in all the facilities I visited were very high. However, I have seen very old buildings which need to be modernised and adapted and made more family-friendly and appropriate to the needs of older people. This requires capital investment and we have made additional capital moneys available, as we did last year, for the adaptation, modernisation and upgrading of many of these facilities. This process must continue, as it will take some time to invest the level of capital funding required to raise all of the facilities to modern standards.
The budget addressed the issue of day care centres and their wider use. As the Deputy knows, many centres are only open for a short period each week. In future, every day care centre will operate seven days per week, which will require additional resources and staffing. This year, the Government has provided money for the enhanced use of the current day care services. I must be honest and say I am not familiar with the details of what is happening at Cootehill, but I will have the matter examined and ask someone to communicate with the Deputy.
Will the Tánaiste revert to me?
The residents of the Cootehill centre should not be put at a disadvantage vis-à-vis residents elsewhere, nor are they as far as I am aware. I want the facilities for senior citizens there to be used to their full potential.
There are echoes of this matter in other parts of the country. We are discussing approximately 200 citizens to be catered for, that is, 40 per day over five days. The commitment of the voluntary input is present, but the HSE——
The Deputy is only allowed one supplementary question.
——is making the voluntary commitment an essential element of what it should be providing. The voluntary commitment should be in addition to what the HSE is obliged to provide, not instead of it. The dichotomy arises in this regard. Will the Tánaiste revert to me on this matter, as it is of significant importance?
I will have the matter examined for the Deputy.
I have always believed that one of the reasons for the reluctance with regard to an independent inspectorate of public sector facilities was that it might file damning reports on conditions and buildings. I share the Tánaiste's concerns and agree with her analysis.
In the context of the Government's tenure and notwithstanding the fanfare for public private partnerships, why has it reneged on its commitment to provide new public nursing homes? How does the Government intend to provide services for people with dementia?
I understand the HSE is working on plans for the provision of additional capacity in this area. Several years ago, my Department proposed to provide 850 beds by way of a public private partnership. However, this proposal never advanced, as it ran into difficulties with the Departments of Health and Children and Finance in respect of costings and so on. Instead, capacity was purchased in the private sector. With tax-based incentives for the expansion of this area in the private sector, many facilities have been provided.
That said, the private sector will not fulfil our needs in this matter. For example, it is increasingly difficult to acquire public or private sector capacity in the centre of Dublin. For older people in Dublin 1, Dublin 3 and Dublin 8 to acquire nursing home places, they would need to move quite a distance from their communities and families, which is unacceptable.
The HSE is working on a proposal to perhaps use public facilities, such as St. Mary's Hospital in the Phoenix Park, Cherry Orchard or elsewhere. We must be imaginative, acquire facilities and adapt them for the use of older people, as it is a priority. Not only is it a priority for older people, their families and society, it is also a priority in terms of resolving some of the issues in the acute hospital system. Recently, up to 400 people were medically discharged by their doctors per day but were not in positions to leave because there were no alternative places to which they could go. This is not a good use of the acute hospital system, which is not a good place to be if people do not need to be there. For a number of reasons, we must address this issue.
Where will the children's hospital be located?
The HSE board will consider the report today, which I have not seen. It will make a recommendation to the Government.
The Tánaiste can tell us where the hospital will be located.
It will be in Dublin.
Will it be on the north side?
It will not go to Cootehill.
Written Answers follow Adjournment Debate.
