Dáil Éireann díospóireacht -
Tuesday, 14 Nov 2006

Vol. 627 No. 3

Leaders’ Questions.

Mr. Kenny

Last Friday Professor O'Neill's report was published on the Leas Cross nursing home where more than 105 people died. It stated that no judgment had been formed where there is a difference of opinion. This is not to say nobody made a judgment; it is a handy, catch-all stating no judgment has been formed.

Opinions differed and patients died, all on the watch of this Government. They were mistreated, neglected and they died. In China this is called human rights abuse, here it is called systems failure. The Government is supposed to prevent such occurrences, never mind stop them. The Departments responsible in this case came, saw, read, watched and knew, yet did nothing. They are still doing nothing. We heard about the industrial schools and how this could never happen again, but it has and, according to the report, it could be happening elsewhere around the country.

In fact, the only thing that has changed is time because, on the evidence of the report, we have merely swapped institutional abuse of our young for institutional abuse of our aged, which is a national scandal. Stopping this requires a Government that takes action because it has first taken responsibility. This means naming Ministers and public servants who must take responsibility and be accountable.

Wrongs were not merely done and systems did not merely fail; people carried out those wrongs. On the Taoiseach's and the Government's watch we have failed the elderly and continue to do so. This is not only about money, as the Taoiseach knows, it is about lives. Is there anyone to blame? Is there anyone on the Government side of the House who will accept any modicum of responsibility or accountability for what we witnessed, knew and saw on our television screens as exposed by Deputy O'Dowd, "Prime Time" and others?

The Health Service Executive, HSE, has shown no accountability. It suggested, if one read the report and the submissions, there is no evidence people did anything wrong. The evidence is that a combination of factors came together resulting in a wrong outcome. That is some indictment.

I ask the Taoiseach, as Head of Government, for his opinion on this. Who does he think is responsible and accountable and what does he intend to do about it?

The Taoiseach

We have discussed the Leas Cross report by Professor Desmond O'Neill for a considerable time and I am glad it has been published. It has identified many deficiencies in the standard of care for older people in that nursing home and in the actions required to uphold those standards. The deficiencies in care are deeply upsetting to the families of those who died in the Leas Cross nursing home and to many others also. The Government understands their distress and will lead the legislative actions and funding decisions to ensure high standards of care are upheld in all nursing homes, public and private, in the State. We have been doing so for some years in fact and there are legislative issues that need to be significantly strengthened, as I said last year when these issues came to light. We know from Professor O'Neill's report and other earlier reports that complaints and warnings were not given the attention they warranted. This is a matter of deep regret.

Professor O'Neill did not engage in an exercise in blame, nor did he recommend disciplinary action but some people involved have challenged his assessment. The report has been sent to the Garda and the Medical Council for their consideration because matters arise that must be examined.

Our priority, as Deputy Kenny asked, is to prevent such events occurring again. The Government is finalising its work on the health Bill 2006, with a view to publication this session. This legislation will create a thorough and robust system of inspections and establish, for the first time, a statutory office of the chief inspector of the social services within the health information and quality authority, which will have specific statutory responsibilities for the registration and inspection of all nursing home places, both public and private. The chief inspector will inspect homes against the regulations governing them and standards set by the HIQA.

The Bill will also strengthen and modernise the registration and deregistration process. New standards for all long-term residential care facilities for older people have already been prepared. The Minister for Health and Children published the draft heads of the Bill, a 122-page document, in the spring. We received dozens of submissions following publication and the valuable comments received have informed the Government's work on the Bill. I will not go through the long list of submissions received from different bodies and groups.

The nursing home regulations, under which the Health Service Executive carries out inspections of private nursing homes, were introduced in 1994. They will be replaced by the new regulations to be made under the proposed legislation, with the objective of strengthening the standards of care for residents in nursing homes.

As I have said on this issue on many occasions, it is a matter of deep regret that these events took place. It is even more regrettable that warnings were not heeded. It is now our task to deal with the issues and I have outlined how we propose to do this.

Mr. Kenny

The Taoiseach continues to defend the actions of the Health Service Executive arising from the O'Neill report into the Leas Cross nursing home. Does he accept that anybody on the Government side has responsibility for this matter? Did the former or current Ministers for Health and Children, Deputies Martin and Harney, respectively, or the former or current Ministers of State at the Department, Deputies Callely and Seán Power, respectively, know anything about Leas Cross? Is there any evidence in the Department that any of this quartet of Ministers knew anything about it given that information appeared to be available far in advance of the "Prime Time Investigates" programme?

The Taoiseach referred to legislative action. The HIQA is all about process. Is the Taoiseach prepared to accept a proposal, published by the Fine Gael and Labour parties today, to establish an over-arching patient safety authority? Such a body would change the culture and ethos and make the patient the real centre of attention in the health system. I am concerned by evidence suggesting that the problems described by Professor O'Neill may well be continuing in other places.

The Taoiseach defended the HSE, which has stated it is implementing all of Professor O'Neill's recommendations. This is patently untrue and what is happening is wrong. On 21 June, Professor O'Neill recommended: "Residents (and their families) of any nursing homes that scored poorly in the ERHA tendering process in 2005 for Heavy Dependency/Intermediate Care Beds should be informed of this as a matter of some urgency, as there is a high likelihood that there are residents with high or maximum dependency in all of these nursing homes." The HSE indicated it was implementing this recommendation but we learn today that it has ignored it since last June and refuses to implement it. Is this not another example of the system coming before the individual and the process being more important than the patient? Is it a case of finding a reason for not putting the interests of patients and families first? Is it not time this function was removed from the HSE and a patient safety authority was established and given an over-arching remit in which the patient, as distinct from the process, systems, analyses and the blather in which the HSE is engaged, is the central focus?

As I stated, old people were maltreated, neglected and died. Did four Ministers in the Taoiseach's Government have any knowledge of this matter? Given the difference of opinion on the issue, will anybody accept responsibility or be held accountable for the fact that 105 people died in Leas Cross nursing home?

The Taoiseach

I will not try to rewrite or argue about Professor Desmond O'Neill's report. We asked Professor O'Neill to produce this report and he has presented it. It would not be helpful for any of us to state he did or did not say this or that or should have said something else. He has presented his report and does not get into the blame game or recommend disciplinary action.

Deputy Kenny asked whether Ministers or senior people in the HSE, most of whom were not even in place when this issue emerged because the executive had just been set up, knew what was happening or were involved. For me to be critical of the people who are now trying to rectify these issues would be totally groundless.

Ms O. Mitchell

God forbid anyone would be held accountable.

The Taoiseach

If Deputy Kenny is asking me, as he almost implied was the case, whether people were totally negligent, did not care about what was happening to the elderly or treated matters as of no concern to them——

Mr. J. O’Keeffe

They were incompetent.

The Taoiseach

——or whether they were incompetent, I do not believe that the senior people in the then health boards were responsible for that.

Dr. Twomey

What about the former Ministers, Deputies Martin and Callely?

An Ceann Comhairle

The Taoiseach is entitled to be heard without interruption. Seven minutes are available for each leader's question. The leader of the Fine Gael Party has already used seven minutes. The least the Taoiseach is entitled to is to be heard without interruption.

The Taoiseach

As I said, the report has been submitted to the Garda and the Medical Council for their consideration and both bodies are examining it.

Mr. Kehoe

Pass the buck.

The Taoiseach

Deputy Kenny believes the legislation and procedures are process and a waste of time.

Mr. Howlin

He did not say that.

The Taoiseach

That is what he said. He said it was blather, process and useless.

We are endeavouring to deal with this situation and there is no need to repeat what I have said in this regard. This was a horror for the families and relatives and we must now put a system in place.

Mr. F. McGrath

The Taoiseach has been in power for nine years.

The Taoiseach

It is not just a process. Legislation will provide, for the first time, for the establishment of a statutory office of a chief inspector for social services with statutory responsibilities for the registration and inspection of all nursing home places, both public and private. The chief inspector will inspect the homes against the regulations governing them and standards which will be set in law.

As legislation goes, the Act is not old. It was passed only 12 years ago but requires to be modernised. New standards for the long-term residential care of people have already been prepared and the relevant legislation will shortly be before the House.

Resources for older people were mentioned in the report. We are spending €1.2 billion and we will continue to increase funding substantially this year, which is almost over, and in 2007. The new funding scheme has brought the budget for the nursing home subventions scheme to €160 million this year. Only a small amount was available for this scheme when we started it. We have also trebled the number of home care packages to more than 3,000. These special care packages started only five years ago and we have increased funding for them to €142 million.

Mr. Stagg

The Government cut the home help service in my constituency. The Taoiseach is engaging in a smoke and mirrors exercise.

The Taoiseach

We are preparing a new policy to overhaul the system of financial support for people in long-term care. Deputy Kenny asked if these things are happening in other places. We have done everything we can with the HSE and its senior and regional staff to ensure that regulations on the level of inspections of work carried out in nursing homes are implemented across the health board system. The Minister for Health and Children made a statement about this on Friday.

Mr. J. O’Keeffe

The Taoiseach should try putting a few competent Ministers in charge.

Mr. Rabbitte

I refer to the Taoiseach's announcement ten days ago, when he said out of the blue that the Government proposes to have a referendum on the rights of the child. We are no clearer ten days later on whether the Government thought this through or what is intended. The Minister of State, Deputy Brian Lenihan, has given half a dozen interviews, diplomatically pouring treacle on our heads but we still do not know the intention of the amendment.

Does the Taoiseach agree there are many things the Government can do without a referendum? I refer him to today's report by the End Child Poverty Coalition, which points out that child poverty rates in Ireland are among the highest in Europe, with no fewer than 60,000 children living in consistent poverty, that one third of children in lone parent households live in consistent poverty and that deprivation is highest in households with children.

The Government target to eliminate child poverty by 2007 in the national anti-poverty strategy has not just no realistic prospect of being achieved but the inequality in our society is widening. We all know poverty in Ireland is spatially diffuse but we also know there are geographic areas where multiple disadvantage is clustered. How can the Taoiseach's Government justify such private affluence living cheek by jowl with public squalor? Does he accept that social welfare increases alone will not address this issue? Specifically, does the Taoiseach agree with the Labour Party proposal that 5% of the national development plan be allocated to these areas of concentrated deprivation? These areas of poverty have been well mapped out, all of the literature exists. A Marshall Plan is needed to transfer resources to these areas of concentrated disadvantage. What is the Government's position?

The Taoiseach

Indicators that have been well analysed, with the UN figures only recently coming out, show that we have lifted 250,000 from consistent poverty, including 100,000 children, over the last few years. The figures used internationally show 6% suffer from consistent poverty and we continue under the national anti-poverty strategy to put resources in place. Social welfare expenditure has doubled in the last six years. Improvement in social welfare rates have led to substantial increased spending on families: one in every three euro spent in the State goes on welfare. Every week 1 million people receive welfare payments, helping them all to one extent or another. The UN human development report, which we must submit figures to annually, states we have continued to increase social transfers substantially, resulting in real improvements in the living standards of those in poverty. The latest EU survey shows that increased resources devoted to social welfare and other services are having a significant impact and mentions the initiatives we have taken in recent years to tackle disadvantage.

If Deputy Rabbitte is asking if I agree with the measures implemented in recent years, taking into account the welfare, health and housing budgets to deal with marginalisation and deprivation, I do. We must continue to do that. The large increases in child benefit we have introduced in recent years have also helped. All of this is necessary, desirable and must continue. The Cabinet committee on social inclusion is dealing with these measures and implementing decisions.

Does Deputy Rabbitte agree that we have made substantial impacts in these areas? I agree with him that we must continue this. We must remove the causes, reduce pupil-teacher ratios and continue renovating accommodation or building more desirable and family-friendly homes. All of these issues are massively costly but we are doing them.

If Deputy Rabbitte is asking how do we equalise wealth so everyone is equally wealthy, I do not have a ready solution and it is no good trying to answer that question.

Mr. Stagg

That is like something the Minister for Justice, Equality and Law Reform would say.

The Taoiseach

The huge social spending we have undertaken should be acknowledged and it is having a major effect, as has been calculated by every local and international body that has looked at the issue.

Mr. Rabbitte

I agree with the Taoiseach that the last 12 years of prosperity have had some trickle down effect in the geographic areas I referred to. I am disappointed, however, to see the Taoiseach follow his Minister for Social and Family Affairs in attacking the statistics as distinct from attacking poverty. The fact remains that 60,000 live in consistent poverty. I never raised any question about us all being equally wealthy, as the Taoiseach put it. How can he use such a term when we are talking about 60,000 children living in poverty, about thousands of children going to school who would not have a meal in the morning if it were not for breakfast clubs, about areas I do not need to name where we can physically see the different strands of deprivation concentrated together?

I did not ask any of the questions the Taoiseach sought to answer. I asked if he accepts there is a necessity to declare war on poverty in the relatively small number of geographic areas where multiple disadvantage is concentrated and if the upcoming national development plan offers the obvious opportunity to do that.

Perhaps the failed RAPID experiment could be resurrected. The Government ran up a 23% increase in public spending in advance of the last general election and as soon as the election was won, the savage 16 cuts in social welfare were introduced. The cruellest cut of all was pulling the rug from under the RAPID programme, with the €1.9 billion promised to underpin the plans prepared in these areas gone as soon as the plans were submitted. That was the cruellest cut by the Government and the former Minister for Finance.

I am asking the Taoiseach if, in the new national development plan, the political will exists on the Government side to address this issue. Some of the Taoiseach's Ministers believe inequality is necessary to drive our society. We do not believe that on these benches. Tackling inequality ought to be a political priority now in a country of our prosperity. Yet there are people living in areas where unemployment is five times the national average.

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach.

Mr. Rabbitte

Children are going to school depending on that school laying on a warm breakfast for them. Some 60,000 children are living in consistent poverty. These are the statistics, which are well-established. There is no point in us arguing about EU or United Nations measurements or anything else. The most recent EU measurement I have states that 21%——

An Ceann Comhairle

I ask the Deputy to give way to the Taoiseach, please.

Mr. Rabbitte

——are at risk from poverty.

The Taoiseach

I gave the figures at the outset. Deputy Rabbitte has asked me if I agree we must continue these policies of assisting areas that are marginalised and disadvantaged. Of course I do.

The point I must make is that we have had significant success because of the formation of the budgets we have introduced in the last number of years, where the less well-off people have got huge increases under the Department of Social and Family Affairs. These include child benefit, tackling disadvantage, increases in social welfare or income support. Over 80% of child income support is accounted for in child benefit. A decade ago it was less than 30%. This is enormously helpful.

We have made significant changes to family income supplement in the past number of years, all the time focusing on working families on low incomes or those who have no employment. That has had a significant effect. The amount of claims we now have for family income supplement shows we are targeting the correct people and families.

We have relaxed the means test for various payments, giving disregards in people's income so they can receive benefits. For those working, people on the national minimum wage are not taxed. We have brought in the back to school allowances, and the Minister, Deputy Brennan, has made significant increases in that and the footwear allowances.

School meals were very limited even five years ago. We are now spending over €10 million on that programme, and I do not think the figure was €1 million five years ago. They are very important for people who would not get meals, and we see this in school attendance reports. People in disadvantaged areas now come to school early in the morning because it is the only way they will get a meal. Clearly there is a problem, and that is the reason we put resources in place to deal with that. We have put in place significant assistance for one-parent families. The biggest act we have carried out is to try to give dignity to people who are less well-off and give them work.

With regard to the RAPID programme, we are allocating literally hundreds of millions of euro to the refurbishment and rebuilding of social housing and facilities. We are spending €2 billion on social housing, and a large proportion of the money from the Department of the Environment, Heritage and Local Government is going into pulling down old flat blocks and renewing other flat blocks. The programme set out ten years ago that would have gone on for the next 40 years is now effectively done. Areas like Ballymun and Cherry Orchard have been rebuilt.

I agree with Deputy Rabbitte that we must keep doing this. I would like to hear people recognising in this House that it takes the UN body, the EU body and the OECD to acknowledge what we have done here in five years would not have happened in 50 years if it was not for this Government.

Deputies

Hear, hear.

Caoimhghín Ó Caoláin

The Taoiseach may recall that earlier this year the head of the HSE, Professor Brendan Drumm, stated it would really frighten the public if the true facts were published on the incidence of MRSA in hospitals and the numbers of people whose deaths were brought about either directly or indirectly by MRSA, with it being the critical or a contributory factor. Those were the words of Professor Drumm. Would the Taoiseach agree the reality is that not only do we not know, but Professor Brendan Drumm does not know the full and true extent of this real horror story going on daily around our hospital sites?

One thing we can certainly agree is that this is an alarming and growing problem which must be of concern to every citizen. I wonder if the Taoiseach is aware, as I have become aware in the recent past particularly, that such is the extent of the growing concern about the incidences of MRSA in our hospitals, many people are now afraid to present for admission to hospital? This is particularly true for older citizens.

When I questioned the Minister, Deputy Harney, about this issue over the past couple of weeks, she gave statistics comparing this State with the North of Ireland and regions in Britain. She claimed we faired well from the comparison. However, she failed to state that the island of Ireland and the island of Britain, collectively with Greece, have the worst record of MRSA in all of Europe. The incidence of MRSA in this State is 70 times that in the Netherlands.

Given that the infections contracted and the deaths which result for so many people are absolutely preventable with proper hygiene, management and vigilance, would the Taoiseach advise us of the steps he, the Minister, the Department and the HSE are taking to tackle this very serious problem? Will he encourage, for example, our hospitals to inform patients and the relatives of those who have died with MRSA present at the time of death of the facts and truth of the situation? The hospitals are currently not doing this.

Will the Taoiseach encourage, as I asked of the Minister for Justice, Equality and Law Reform last week, other coroners throughout the country not to wait for the coroners Bill but to emulate the Dublin City Coroner's request for the information to be proffered before the issuance of a death certificate? Will the Taoiseach accept that as the 1995 guidelines for the prevention of MRSA infection have not been properly implemented, and that urgent action is now required to address this serious problem, there must be much great proactivity on the part of all those who can bring about best practice within each of our hospital sites?

The Taoiseach

I addressed this at some length earlier this year, in the spring. The HSE has been indicating to the Government for the last year or so that it has changed its process and procedures in public hospitals with regard to MRSA. It recruited one of the international specialists in this area, an eminent person involved with the issue on the international stage, to bring our standards up to that of other countries. There is a range of well-documented reasons the problem is different on these islands than in the Netherlands, as well as other problems. I will not go into that.

The difficulty is that most of this relates to hygiene standards, and the acceptance that clinical practice has not been up to the standards it should have been. There are now officers in each of the hospitals dealing with these matters and enforcing them. There are health audits and a whole set of procedures and protocols, from washing hands to swabs, theatre treatment to gowning up. An enormous range of procedures have been put down across the hospitals.

These hygiene standards are making a significant impact, as we have seen from the audit reports. The HSE has pointed out that these practices must continue to be implemented. It concerns cleaning standards, cleaning contract standards, procedures in wards and staff such as medical teams moving from ward to ward. These issues were not implemented previously. As everybody has always known, infection can lead to contamination of one kind or another, and cross-infections can lead to death.

This does not only relate to MRSA, as there is a whole range of infections. Everybody knows MRSA, but I have heard ten or 15 infections in presentations on this issue.

The Deputy asked me about the coroner's report. It is not just a matter for the Dublin coroner but for a number of coroners to give the full extent. It is best for the coroner's report to give the facts to families. From the Government point of view, the Minister for Health and Children, Deputy Harney, has tackled the issue of resources head on.

Mr. J. Breen

She has not. I am a victim of the MRSA superbug, and the Government has done nothing.

An Ceann Comhairle

The Deputy should allow the Taoiseach to continue without interruption.

Mr. J. Breen

The families of MRSA victims will tell the Taoiseach that. He did nothing but stand there and waffle.

An Ceann Comhairle

I ask the Deputy to allow the Taoiseach to continue without interruption.

Mr. J. Breen

I am a victim of the MRSA superbug and I nearly lost my life as a result, then the Taoiseach stands up and waffles. Nothing is happening and the families of MRSA victims will tell him that. What is the Minister doing? She is doing nothing.

An Ceann Comhairle

I ask the Deputy to allow the Taoiseach to continue without interruption.

Mr. J. Breen

I will not sit and listen to waffle.

An Ceann Comhairle

Deputy Breen, I ask you to allow the Taoiseach to continue without interruption.

Mr. J. Breen

I am a victim of the MRSA superbug.

An Ceann Comhairle

If the Deputy wishes to raise the issue in the House, the Chair will facilitate him but not at Leaders' Questions which is confined to the leaders of the three parties in opposition.

The Taoiseach

The Coroners Bill is being prepared. I understand there is no difficulty preventing the coroners giving the full reports, but I will raise that issue because the families should be given the full facts and details and there is no reason that should not happen.

Caoimhghín Ó Caoláin

We must accept that Deputy Breen's intervention is totally and absolutely understandable. We have seen the tremendous anger and fear as a result of the greater awareness of MRSA. I welcome his intervention.

An Ceann Comhairle

I suggest the Deputy should not welcome disorder in the House.

Caoimhghín Ó Caoláin

I know the Ceann Comhairle would take that position but I have very little time. As demanded by MRSA and Families Network, the campaigning group, will the Government set up a national directorate for the inspection, prevention and control of MRSA and other hospital-acquired infections? That is a critically important point. The seriousness of this issue cannot be overstated. I cited here only a week ago the incidence of a lady who presented at one of our hospitals for the removal of a kidney stone, contracted bed sores and MRSA in her ankles as a result of same, and left with both her legs amputated. This is a very serious problem.

Last evening I met a family in County Donegal whose wife and mother is now several weeks over the original scheduled timeframe for her presence in hospital. The reason is suspected MRSA but again the hospital authorities are not being open with the family and they have not acknowledged what is the reason for her long, protracted and current serious state of health. We must get to a point where the truth is shared at all times and where families and those who are victims in hospitals are told the full facts.

Is the Taoiseach aware that the measures outlined in the 1995 guidelines do not apply beyond the hospital sites? With reference to the Leas Cross report, it is critically important that these measures are extended to all care facilities, not only hospitals but nursing homes and community settings as appropriate? Will the Taoiseach heed the call of MRSA and Families Network, specifically for the Health Information and Quality Authority to expand its role and responsibilities to include hospitals, nursing homes and other settings and to report its findings directly to the national directorate? I appeal to the Taoiseach.

The Taoiseach

The legislation will be before the House shortly and Deputies will be able to put their points of view. The Health Service Executive authority has made it very clear to us that it has put together and is endeavouring to implement inspections and hygiene standards to defeat infections and cross infections, to implement protocols for gowning, washing and transfers of food covering a range of areas in hospitals and hospital-related areas to address the substantial problems that have existed over the past few years. The hygiene audit, which has been published in an open and transparent manner, shows where the improvements have been made and where there are still difficulties. Dedicated staff have been assigned to a unit the aim of which is to overcome not just MRSA but a range of infections that have always existed in hospitals and health facilities throughout the world.

On the question of transparency in dealing with patients and families who have lost people, the Government believes all these issues should be dealt with in a transparent manner. There is no reason anybody should not be given full details of post-mortems or other procedures. This has been the practice in the health service, it is Medical Council policy and it should be done.