Dáil Éireann díospóireacht -
Wednesday, 15 Nov 2006

Vol. 627 No. 4

Health Services: Motion (Resumed).

The following motion was moved by Deputy Twomey on 14 November 2006:

That Dáil Éireann,

conscious of issues which compromise patient safety such as those exposed in:

the Lourdes Hospital Inquiry Report;

the report on the death of Mr. Pat Joe Walsh;

the case of Mr. Peter McKenna; and

the Leas Cross reports;

aware that the creation of one single employer, the HSE, for a majority of the staff who work in the health services, supports the case for the establishment of an independent body with a strong legislative base which is focused on patient safety;

calls on the Government to:

immediately establish a patient safety authority to put patient safety at the heart of the health services and tointer alia:

set and monitor standards of patient safety in all registered health and social care facilities;

advise on patient safety, investigate complaints and carry out quality reviews;

act as the commissioner for mental health services; and

facilitate "whistleblowers".

Debate resumed on amendment No. 1:

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

"—welcomes the Government's commitment to promoting patient safety and high-quality health services and in particular to the setting up of the independent health information and quality authority which will progress the safety and quality agenda in the health services through setting and monitoring of safety and quality standards;

supports the Government's commitment to introducing legislation which,inter alia, will establish the social services inspectorate on a statutory basis, including a robust system of inspection and a strengthened registration and deregistration;

notes the proposed statutory role for the first time of the Office of the Chief Inspector of Social Services in inspecting and maintaining registers of residential centres for people with disabilities, children in need of care and protection and older people in public and private sectors;

notes the Government's commitment to ensuring that high-quality care is made available to all patients in public, private and voluntary nursing homes, and, in that context, welcomes the preparation of new and stronger regulations to update for the first time the Nursing Homes (Care and Welfare) (Amendment) Regulations 1994 and standards for residential care settings for older people;

welcomes the HSE's provision of information to the general public on nursing homes and its policy decision to make nursing home inspection reports available on its website, and, in particular, welcomes the publication of the Leas Cross report;

acknowledges the work which has been initiated since the publication of the Lourdes Hospital inquiry, including action at local level to improve clinical accountability and performance in the hospital;

recognises that high patient volumes are needed for specialist services to achieve the best clinical outcomes;

acknowledges the need to ensure that medical and surgical procedures are carried out at appropriate levels within the hospital network for best patient outcomes;

supports the Government's commitment to reforms that will achieve improved safety and quality outcomes for patients;

acknowledges that the HSE has put in place management structures at both corporate and hospital level with responsibility for ensuring quality and minimising risk;

notes the Government's commitment to the development of a protected environment in which staff may disclose concerns about patients' safety;

notes that the Minister for Health and Children will introduce regulations in early 2007 which will set out a statutory framework for the introduction of a complaints process throughout the HSE;

supports the important role of the Irish Health Services Accreditation Board and its work in applying accreditation standards to ensure safety and continuous quality improvement; and

commends the Government on measures to ensure that the patient safety needs of people with mental illness are monitored and protected by the Mental Health Commission and the Inspector of Mental Health Services.

—(Minister for Health and Children).

Dr. Devins

I wish to share time with Deputies Fiona O'Malley, Cooper-Flynn, Callanan, Fleming and Moloney.

I am delighted to have the opportunity to speak on this Private Members' motion on patient safety. Anyone who has involvement in the provision of health care, be it in the front line or through a family member or friend recovering and receiving care, or even at the political level, will want the highest level of patient safety. We also want the quality of the health care to be of the highest level. There is no doubt that a significant minority of patients can be harmed because of their involvement with the health services. While this potential has always existed, and unfortunately will always exist, it would be foolhardy in the extreme to ignore it.

We must seek to keep adverse effects to a minimum. Where they do occur, there must be an open and transparent system of reporting, investigating and hopefully preventing a recurrence in the future. For this to happen, it is essential that a mind change occur within those who work in the health care system. For far too long, defensiveness has been the over-riding response to adverse effects and costly and long drawn-out litigation has been the ultimate result. I warmly welcome the adverse event reporting system established under the clinical indemnities scheme. This will allow all those working in the health care system to identify, examine and learn from mistakes made. The advantage at local level is that such an adverse effect will lead to a rapid local analysis and response which should result in the issue being resolved quickly. Another advantage is that any such issue will be reported nationally. This can provide information to the HSE so mistakes made in one of the old health board areas can be avoided elsewhere. This is one of the great advantages of the national remit of the HSE.

I note the Minister welcomed the Leas Cross nursing home report in the House last night and that the HSE will work to implement its recommendations as quickly as possible. It is vitally important the team of nursing home inspectors be trained and put in place as soon as possible. There are many excellent private and public nursing homes dotted all over the country. Sligo has St. John's Hospital and Nazareth House as public facilities and Summerville and Mowlam as private ones. I know from my experience of dealing with them they all operate to the highest standards.

There is nothing to fear from having a stringent inspection process. Patients and their families will be reassured by the fact that regular and unannounced inspections will be carried out. The secret to inspections is to make them unannounced. In that way, no one can accuse the institution of being forewarned.

What happened in Leas Cross was totally unacceptable and must not be allowed to occur again. I commend the Minister's actions in this regard and I support the Government amendment to the motion.

Ms F. O’Malley

I concur with the sentiments expressed by Deputy Devins and I welcome the debate that Fine Gael has set out. The last time I spoke on this issue was just after the "Prime Time" report. I echoed the sentiments expressed at that time by many Deputies that "Prime Time" had performed a great public service by highlighting the patient safety issue. It rightly focused us, for a change, on the treatment that elderly people within our society are receiving. I joined colleagues at that time in looking for legislation to be enacted to deal with the issues raised.

In that regard members of the Government have faced a "damned if we do, damned if we do not" scenario; we are criticised when legislation is introduced too slowly or too quickly. The Minister has simultaneously been accused of acting too quickly in terms of reform, and for acting too slowly on the relevant legislation. It seems she can never get it right. Some of the contributions so far would lead one to believe no action on the necessary legislation has taken place. The heads of the Bill were published by the Minister, Deputy Harney, in March this year. It is extraordinary, bordering on the hypocritical, for some in the Opposition to cry foul at this point, given that of the approximately 70 submissions received in the three-month consultation period on the Bill, not one was received from Opposition parties.

Dr. Twomey

What is the big surprise about that?

Ms F. O’Malley

The parties were given the opportunity to help draft legislation.

Dr. Twomey

I hold the Government to account in this House. We do not do it somewhere else. This is where we hold it to account.

An Leas-Cheann Comhairle

Allow Deputy O'Malley to continue without interruption.

Ms F. O’Malley

Not one submission was received from the Opposition. Does the public realise this was the case? I doubt it. Opposition parties did not make one suggestion on what should be included in the Bill, nor indeed were any views on the proposals offered.

Dr. Twomey

We published our own proposals.

Ms F. O’Malley

This was a poor performance and a test of the Opposition's sincerity on the issue. They have been found wanting.

Mr. O’Dowd

The Minister for Health and Children is a joke.

Ms F. O’Malley

On the substantive point, what the Opposition did muster was a call for a new so-called patient safety authority. This is strange given the Health Information and Quality Authority is already in place, albeit on an interim basis.

The call for a patient safety authority seems quite restrictive, timid and unambitious given that the Minister's Bill provides for inspection of all nursing homes, both public and private, as well as residential centres for children and people with disabilities. The Opposition has sets its sights quite low, and the Government is correct to provide for a wider remit. All of these residential locations must be subject to rigorous and effective inspection. The Government's Bill is much more ambitious than anything Fine Gael has proposed in this motion.

It is reminiscent of Fine Gael's unambitious commitment to delivering 600 new step-down beds when the Minister has already explicitly said the HSE is to use as many public and private nursing home beds as required to free up beds for patients awaiting admission. Acute beds that become available as a result will be ring-fenced for those patients awaiting admission in accident and emergency departments. It is as many as is required and not just 600.

The Minister for Health and Children's Bill is evidence of the Government's determination to make patient safety the driver of major reform throughout the health system. It sets new standards, will strengthen the inspection regime, and ensure the gathering and publication of new information on services. This approach has delivered progress on hospital hygiene and must work within this sector. I welcome all positive and realistic contributions from all sides of the House. Much is being done, and this is needed because there is no doubt that problems persist. This acknowledges the persistence of these problems.

The Government is working to make patients' voices increasingly heard. Only then will the correct decisions and actions be taken. The Government has made it clear that as many services as possible will be made available as locally and as safely as possible. We must recognise the problems, the action needed and the action already under way. To do otherwise serves nobody, least of all the patient. While raising this issue is commendable, it would be more commendable if it were done in the context of an engagement which was positive and ambitious and which recognised the work already achieved.

Ms Cooper-Flynn

I also welcome the opportunity to speak in this debate. Everybody in the House recognises that patient safety and care should be at the centre of our health policy. Like other Members present, I welcome the publication of the Leas Cross report. We were all shocked when this matter came into the public domain last year. It caused much concern not just for the patients of Leas Cross but for patients of nursing homes across the country because of a lack of confidence in the nursing home inspectorate system. While I welcome a number of changes that have occurred over the past year, as we all know there has been considerable media comment that despite the improvements in the inspection system it is still not all it should be. I welcome the introduction of a new national training programme for inspection team members and the hiring of 32 elder abuse officers. I also welcome the fact that under the new Health Bill 2006 the social service inspectorate will be put on a statutory basis. That is critical.

In my limited time I will deal with some specific issues. As we discuss patient safety and care the inequality of the subvention rate across the country amazes me. I have mentioned this time and again in this House and at the Joint Committee on Health and Children. I mention it because it has a critical part to play in patient safety and care. Many patients, particularly in the west, are not receiving the standard of care they should because of the inequality in the subvention system. In the past I have mentioned that in my county one cannot get enhanced subvention. It has been discontinued for new applicants since the spring. The maximum subvention one can get in County Mayo is €190.50 per week, compared to €850 which patients in the east can get. That is a scandalous gap of almost €700. Are we saying older people in the west are not entitled to the same standard of care as those in the east? The Minister for Health and Children has acknowledged, at the Oireachtas Joint Committee on Health and Children, that it is inequitable and discriminatory, and she has said she intends to do something about it, as has Professor Brendan Drumm.

If a person is unable to get a bed in a public facility and qualifies for the maximum subvention but cannot afford to pay the balance between the subvention, combined with his or her pension, and the cost of a private nursing home, what is he or she to do? We have acknowledged that the person is entitled to the maximum amount of subvention and care available, but he or she cannot afford to pay. This scandal has gone on for too long and must be rectified as a matter of urgency. Enhanced subvention could be reintroduced immediately. Although the Minister allocated an extra €20 million in last year's budget to deal with this issue, that money had been spent before it was announced and it made no difference in subvention rates. I welcome the commitment given by the Government in the social partnership agreement Towards 2016 and I have spoken to the Minister for Health and Children about this. The commitment will be that the level of State support for residential care should be indifferent to whether a person is in a public or private facility. I agree fully with that, but we are a long way from it. Although it will cost a large amount of money to implement it, if we are serious about patient care and safety it must be done as a priority. I have already mentioned that the €20 million from last year was inadequate and I ask that enhanced subvention be restored as an interim measure.

I have a number of other important policy points dealing with patient safety and they were part of the ten-point plan to deal with the accident and emergency crisis. People have referred to contract beds. There is not one contract bed in County Mayo. When I last raised this at the Joint Committee on Health and Children I was told that negotiations were ongoing, however nobody could tell me how many contract beds would be allocated to the county or what stage negotiations had reached. I was told they were due to end shortly, but we are still waiting. The home care package initiative is fantastic and I welcomed it wholeheartedly when it was introduced. However, while 500 home care packages were announced nationwide last year, only five of those were available in County Mayo. How can that be a real option for an elderly person? How can we be serious about caring for people in our community and providing adequate patient care if only five are available in a county of 110,000 people where we have already acknowledged that approximately 16% of the people are over the age of 65? I am glad to say that has improved.

As a result of my bringing the matter before the Joint Committee on Health and Children approximately 60 home care packages are available for 2006, but that is still inadequate. The majority of people in my county receive a maximum of approximately five hours of home help per week. If we are serious about a policy of patient care and safety we must ask ourselves, despite the extensive resources being spent on health, whether that is adequate.

I was going to mention a sad case in an acute hospital I dealt with recently, but I do not have time. If even some of those issues, particularly on looking after the elderly in their own homes, the home care packages and the contract beds, or only equalisation of subvention rates, could be resolved it would be a major step forward.

Mr. Moloney

I also welcome these few minutes to speak in this debate and to support the Government amendment. I welcome the fact that the Minister has made it clear that this is about patient safety, not just about hospital buildings and where hospitals should be located. I welcome the fact, particularly arising from the Leas Cross report, that we will at last have statutory inspections and not pre-planned visits. As a member of a former heath board, I often witnessed the nonsense of notifying the local hospital or nursing home of the possibility of a visit. At last we have seen a robust attack on the service area to ensure that the Minister's commitment will be honoured and I welcome that. It is important that the legislation coming before the House will strengthen regulation and inspections and this will go a long way to assuring the public about quality and safety. People are concerned at the lack of accountability. They hear of incidents occurring in nursing homes and it causes great alarm.

It is important to reflect on what the Minister has said about the numbers of patients presenting for surgical procedures in some hospitals. It is important that we realise it is not just about flying the county hospital flag. It is important that patient safety is taken into account by way of the levels of procedures provided in some institutions. Recent figures indicate the proportion of patients treated by consultants doing more than 50 procedures per year has increased from 23% in 1997 to 58% in 2003. We must welcome this. Figures recently released indicate that 308 of 1,800 patients have had their surgery performed by consultants doing fewer than 30 procedures per year.

We must take patient safety into account. Arguing a case purely to keep a local hospital open but abandoning the possibility of ensuring patient care is something all public representatives must consider. A further figure was of the 76 consultants who carried out breast cancer surgery in 2003. Some 45 had carried out fewer than ten procedures a year and 37 had performed five or less. When debating the need for specialised care and supervision, it is incumbent on the Government to ensure that if we are citing local hospitals that need to retain their services we take into account that it is vital for patient safety that the surgeons involved are up-skilled and at their best, and they will achieve this only by the level of treatment they carry out.

Groups coming before the Joint Committee on Health and Children have made me aware of MRSA and patient safety. The committee has discussed this regularly with the HSE and the families of those who have unfortunately been affected. The point has been made that we need a regulator or somebody in control, to whom reports are made, to ensure that the maximum safety measures and procedures are in place. It has also been said that the time has come for someone at local level to be responsible for enacting policies that ensure the MRSA bug can be eliminated. I support the amendment and what the Minister is trying to do. It is very important that she has made the point that it is not just her job to ensure we have the best standards by way of hospital construction and services; it is more important to ensure that staff providing those services are trained to the highest professional standards and can ensure the delivery of excellent services.

Mr. Fleming

I welcome the opportunity to contribute to this debate. Again, the whole emphasis is on the patient and that is as it should be. Thankfully, we have come a long way from the situation where a hospital administrator would claim the hospital would work perfectly were it not for the patients. That attitude needed to be rooted out of the system and hopefully it is now long gone.

I particularly like the commitment in the amendment to a new social services inspectorate, to be run on a statutory basis, and that will be brought forward shortly in the new legislation. That is essential and I hope it will be an inspectorate with teeth and power. It is important that it be given graduated powers and sanctions. If there are minor problems sanctions may be taken against the nursing home in question while more serious offences will justify graver penalties. Ultimately, if a situation is unacceptable, the inspectorate will have the power to close a particular establishment on a temporary or full-time basis, depending on the circumstances. However, the idea of a sole option available to an inspectorate as the draconian all or nothing — to close an establishment completely or take no further action — has often led to mistakes being made in the past and I hope the legislation will take this into account.

It is important that the new inspectorate deal with public and private nursing homes and facilities. The view at present is that it is the private sector establishments that need inspections. It is good for staff and those who run the public sector facilities as well to know that they are subject to independent inspection and it is good for morale to be given a nice clean comprehensive report. It is also to be welcomed that inspection reports for nursing homes are on the Internet. That is a major step forward, one that everyone will agree is a welcome and modern development.

The legislation will provide that staff can make complaints without fear of retribution. Although it is not being highlighted as a major achievement, that, in practice, could be the most important element of the legislation. With more than 100,000 employees in the health service, there is a complete range of service providers in each section from medical care to catering staff. It is good, if people believe a patient is not being treated properly, that they can make a complaint without their careers being affected. It is important that this protection is in place. It is welcome, too, that the statutory complaints process will be enshrined in the new legislation, so that people may make formal complaints. An independent review mechanism and a proper system should be set up.

Up to now the role of the Ombudsman has been an underused resource as regards the HSE. From my experience as a public representative I have encountered some difficult cases in tragic situations, where the official shutters come down in the HSE, or in the health boards as they were. Sometimes the Ombudsman can help to mediate successfully without matters having to reach the litigation stage. The Ombudsman, Ms Emily O'Reilly, has the ability to go into the HSE and make recommendations for improvements. I believe the HSE would welcome this and we should see greater use of the Ombudsman's office in HSE affairs in the years ahead for the betterment of the health service.

Mr. Callanan

What happened at Leas Cross was completely unacceptable. Since the emergence of the issues raised by Leas Cross the HSE has made many improvements in its nursing home inspection process. The working group on nursing home inspections and registrations produced a report in July this year which set out a consistent and robust template that now underpins the inspection process. The HSE has embarked on a programme of standardising inspection reports across the country in accordance with current legislation. As part of this process there is significant engagement with the private nursing home sector and the nursing home inspection teams.

Most of the private nursing homes are providing very good care. With more inspections being carried out without prior notice we can look forward to an excellent standard of care in our nursing homes. It is very important that we continue to provide public geriatric beds and I welcome the decision to build a new unit at St. Brendan's hospital, Loughrea, where care of the elderly is of a high standard. I compliment the nurses and everybody involved at that hospital. I also welcome the proposal to build a new community nursing home in the grounds of St. Brigid's Hospital, Ballinasloe.

I attended a meeting in Claregalway at the weekend concerning private nursing homes. The sons and daughters and other relatives of elderly people in such institutions attended the meeting to discuss nursing home subventions. Speaker after speaker said how difficult it was for them to keep their elderly in nursing homes due to the lack of proper subventions. This is a topic I have spoken on before because the rate of payment in Galway is one third of what is being paid in the eastern part of the country. I know the Minister is reviewing the situation with a view to creating a better and fairer scheme for the elderly in nursing homes, and I welcome this. I also welcome the Minister's introduction of the home care packages. I have long promoted the notion of home-based subvention, but I have always felt an old person should have the choice of being looked after in his or her own home for as long as possible. This can now be done under the home care packages, but we must increase the budget for this service as there will be growing demand for it.

Social services that provide day care and meals and wheels for older people do not get the recognition they deserve. I am very familiar with Ballinasloe and Portumna social services, which provide excellent services and care for many elderly people, who mostly live alone, by providing them with hot meals and bussing them to day centres, two or three days a week. There they meet their elderly friends and enjoy themselves, while being looked after by caring staff, most of whom are voluntary. This type of service keeps hundreds of elderly people out of hospital and would cost the State millions. I ask the Minister to provide greater funding for such groups.

I also welcome the increase in funding for home helps in 2006, bringing the budget for that area up to €30 million, which is providing more home help hours for those who need them. It is the Government's policy to maintain older people in dignity and independence at home, in accordance with their wishes, while at the same time providing high quality residential care when they can no longer be maintained in this manner at home. Forecasts suggest that by 2031 the percentage of the population aged over 65 will be between 18% and 21%. The Government is committed to services for older people, both residential and community based, to meet the demands of a growing elderly population. From 1997 to 2005, inclusive, additional spending on health services for older people was in excess of €302 million. The total spend in 2006 will be €1.2 billion. I compliment the Minister on her great work on behalf of the elderly and I support the Government's amendment.

Mr. Gormley

I very much welcome and support the motion being put forward by Fine Gael and the Labour Party. I listened to the contributions of previous contributors, Deputies Devins and Fiona O'Malley. Deputy O'Malley said this was a Government which listened to patients. Not only does it not listen to patients, it does not listen to their loved ones and it does not listen to Deputies. The Government set up the HSE, which is a further layer of bureaucracy. We find it very difficult to even get answers to parliamentary questions at this stage.

One only has to look at the treatment of patients by this Government to see it does not seem to care. I have dealt with a number of Ministers during the tenure of this Fianna Fáil-Progressive Democrats Government. I tried to make representations to them on behalf of those who suffered symphysiotomy but I was stonewalled. Let us consider the Dunne inquiry and whether the loved ones were heeded. They have received no satisfaction, nor have the victims of the hepatitis C scandal. It seems the routine is that the wall comes up every time. This is regrettable.

Deputy Devins referred to a procedure to examine adverse effects. In the aftermath of a bad election, politicians hold a post-mortem and consider what went wrong. There is no post-mortem examination in the case of clinical adverse effects. This is also the case in Britain with the NHS.

I urge the Minister of State to read an article in yesterday's The Independent. A pilot, Mr. Martin Bromiley, gives an account of the routine operation carried out on his wife. The operation went wrong and she died. He examined safety procedures in the NHS and was shocked to find out that there was no training of doctors and nurses to deal with emergency situations. The article states:

The risk of dying on a scheduled aircraft flight today is one in 10 million. By contrast, Bromiley now knows, the risk of dying in hospital as a result of medical error is one in 300. That means hospital treatment is 33,000 times more dangerous than flying on a scheduled airline.

Either one can be confident boarding an airplane or one should be very nervous going into hospital.

A Fianna Fáil Member told me that one would be better off having an operation on the kitchen table, considering the high rates of MRSA in our hospitals. Mr. Bromiley has been asked to speak at a number of conferences on the need for proper training for those in operating theatres and elsewhere in our hospitals. During Mrs. Bromiley's operation, a simple tracheotomy was needed but none of the medical staff at the operating table could do it. The article quotes Mr. Bernard Ribeiro of the Royal College of Surgeons: "Professional failures are more often due to behavioural difficulties, personal conflict, lack of insight, systems failure or defective infrastructure than technical failings or lack of knowledge."

If we had protection of whistleblowers, we could make some progress. A whistleblowers Bill was published but it became stuck on Committee Stage and has not been seen since. There is fear of accountability and transparency. If we had it, Leas Cross would not have happened, nor would the case of Dr. Neary at Our Lady of Lourdes Hospital, Drogheda. I support this proposal for legislation.

Caoimhghín Ó Caoláin

Ar son Teachtaí Shinn Féin ba mhaith liom tacú leis an rún seo in ainmneacha na dTeachtaí Fhine Gael agus Lucht Oibre. This is a timely motion in the wake of the report by Professor Des O'Neill on the scandalous neglect of vulnerable people in the Leas Cross nursing home. The publication of the report is a further damning indictment of successive Governments and health board or HSE bureaucracies that presided over a system that allowed the old and the vulnerable to be treated disgracefully in nursing homes. There is no doubt that inadequate staffing, inadequate care and, most seriously, inadequate vigilance by State authorities led to the deaths of patients in Leas Cross and in other nursing homes.

The terms of reference given to the author of the report, Professor O'Neill, were flawed as they only provided for a documentary inquiry. The relatives of the deceased were not given the opportunity to participate even though they have valuable evidence to give about the treatment of their loved ones. Some of them have given moving and harrowing testimony in the media. Others have stories to tell also and have a right to see them placed on the record and outside the glare of media if they so choose. The Minister for Health and Children should provide a forum for the relatives to make this evidence available.

In the wake of the initial exposé of the scandal of Leas Cross, both the Minister for Health and Children and the Taoiseach promised a nursing homes inspectorate. This has not been delivered. The Government also needs to implement the recommendations of the National Economic and Social Forum report on the care of older people. It needs a clear strategy to end the over-reliance on private nursing homes for the care of older people and to ensure that all those who wish to be cared for in their own homes can be facilitated with the full support of all relevant State services.

We have waited for years for the Health Bill to put the health information and quality authority and the social services inspectorate on a statutory footing. When all those structures are in place, the Government must ensure their effectiveness. Otherwise, we will simply be creating further layers of bureaucracy. Whatever body has overall responsibility for patient safety must be independent and must cover all care settings. The MRSA and Families group has highlighted the fact that different regimes for infection control and prevention operate in public hospitals, private nursing homes and other sites where residential care is delivered. This must be addressed as a matter of urgency. Consistency is needed across the board.

A lack of accountability in sections of the medical profession and a lack of vigilance by the State authorities led to the ordeal endured by women in the Our Lady of Lourdes Hospital in Drogheda in the 1970s and 1980s. The women affected are still seeking justice and the full truth. The Leas Cross scandal occurred in the past decade. While the further measures introduced in the wake of Leas Cross to address patient safety are welcome, the question must be asked how many other similar cases of neglect were going on throughout the county at the same time as Leas Cross. How many deaths are attributable to such neglect? We may never know.

The motion mentions the case of the late Pat Joe Walsh who bled to death in Monaghan General Hospital because a diktat from on high decreed that a life-saving operation could not be performed on him in that hospital. I extend continuing sympathy to his family, which is now contemplating legal action. This is yet another family who feel driven to resort to the courts to get justice because of the treatment of a loved one within the health care system. It is a disgrace that they should have to do so.

What is the Government's response to the case of Pat Joe Walsh in its amendment to this motion? It asks the Dáil to "recognise that high patient volumes are needed for specialist services to achieve the best clinical outcomes". With all due respect, I do not have to be a Deputy for Cavan-Monaghan to identify that as a pathetic response. The systematic cutting of services at Monaghan General Hospital has led to the deaths of patients, including that of Pat Joe Walsh. The policy of over-centralisation of hospital services is based on a skewed interpretation of the training requirements of medical staff, the demands of insurers and the interests of medical professionals concentrated in the larger hospitals. It is being driven by the Government and the HSE.

In the north-east region we are promised a new super hospital sometime in the future. In the meantime, local hospital services are being cut. The Teamwork report is the same strategy of over-centralisation wrapped in a new package and it has been comprehensively rejected by those in my constituency. I reject that report and restate Sinn Féin's demand, in common with campaigning communities, for our local hospitals to be given the rightful place in the health and safety of patients.

Ms C. Murphy

Last Friday, I attended the opening of a nursing home in my constituency. It is one of a number of new facilities that have been developed recently and more are planned. This is evidence of the growing need to make provision for our elderly. It is a major step for frail people or elderly couples to leave their homes, move away from the neighbourhoods with which they are familiar and move into nursing homes. However, I fear many of them are moving into an environment that more closely resembles a hospital than a nursing or retirement home. I have noticed a fundamental change in nursing homes due to the shortage of hospital beds. The ratio of high dependency patients is growing continually. I do not refer to people with conditions such as dementia, but to people who are attached to drips and who undergo ongoing acute treatment of the kind one would expect to see in a hospital. Higher proportions of people with acute illnesses affect the social environment and create a higher risk of infection.

Members must understand that terms such as step-down facilities also have consequences. While medical consequences must be anticipated and responded to, social consequences are as important if elderly people are to enter retirement homes to live out their lives. This implies good levels of activity and social interaction, which become difficult with disproportionate numbers of people who are very ill.

I support the motion before the House, which seeks a patient safety authority. I have heard words such as "robust" used in respect of the so-called new arrangements. Unless new arrangements are backed by defined standards, the availability of adequate resources and accountability when failures occur, cases such as Leas Cross will continue to arise. There must be a separate agency to police standards.

Mr. J. Breen

The establishment of a safety authority in both the United States and Britain has been welcomed by patients, their families, the health care providers and their insurers. Such authorities operate in a manner similar to that used in aviation, whereby serious incidents and near misses are reported to a central authority, thus helping to identify early trends, epidemics and misdiagnoses throughout the health system. This can reduce potential maltreatment and serious errors at a later stage.

It is imperative that such a system respects the confidentiality and identity of staff, hospitals, health care centres and patients. My constituency office receives large numbers of calls from people on a daily basis that highlight problems they have encountered in hospitals, nursing homes and the health service. Such callers constitute a cross section of hospital patients, visitors and staff. The establishment of such an authority would help to get rid of some of the problems raised. They would be addressed more quickly if staff in particular could avail of a whistleblower facility.

The British patient safety authority produces quarterly national reports that are available for public inspection. Hospitals that report to the authority are named on the authority's website. This increases public confidence in such hospitals. The principle behind such an authority is to find out how problems occurred, rather than who was at fault. In addition to improving patient care, such solution-based systems give rise to better risk management in the health service and consequently, to cheaper insurance premiums for health care providers.

It is time for the Minister for Health and Children, Deputy Harney, to come clean and publicly state what the future holds for our hospitals. In County Clare, Government Members publicly praise the allocation of €25 million for the development of Ennis General Hospital and a new CAT scanner was recently announced for the hospital. However, in a meeting last week with county councillors and Deputies from County Monaghan, the Minister stated that 26 hospitals nationwide would have their services downgraded next June, after which only one regional hospital in each area would retain full services. Does that mean that Ennis General Hospital will lose its doctor-led accident and emergency service next June after the general election is out of the way? It is time to put an end to the half truths and misleading statements emanating from the Minister, other Government party Members and the Health Service Executive and put patient welfare at the forefront of our national health care policy.

Dr. Cowley

One does not need to look far to see the gross neglect of older people by the Government. I will provide three examples. First, older people in my county who only have their pensions cannot get transport for essential hospital appointments. Second, half a dozen home care packages were announced last year. Although this figure may rise to 50 this year, they have not progressed past January because the service is cash-strapped. Third, I refer to the terrible scandal of people who have nothing and yet must try to find money to receive basic care and to stay in nursing homes. This is a complete abdication by the State to the private sector and it is not working.

A few days ago, Members saw how the HSE was obliged to stop sending people to certain private nursing homes. This was due to understaffing because such nursing homes are profit-based. The State should take over such care. The State has a legal obligation to care for people with extremely high dependency across the board at its own expense. This is how it should be and I call for its implementation. Moreover, not-for-profit ventures are the way forward for high dependency individuals. There has been complete neglect on the part of the Government. The examples I have given make it clear that the way forward for those with high dependencies is for the State to take over their care.

Mr. Connolly

I support this timely motion. The case of Mr. Pat Joe Walsh has been dealt with by my colleague, Deputy Ó Caoláin. I want to know what is the Government's position in this regard? The kind of step-down facility it hopes to provide in County Monaghan caused the death of Pat Joe Walsh. I cannot accept that.

As for the Teamwork report, many people believe it will not apply to them. I remind them that initially, it will apply to four counties in the north east. It is a pilot project and will eventually be rolled out nationally. While it will not happen before the next general election, it will come to people's doors.

Moreover, after the next general election, there will be further closures of accident and emergency departments nationwide. People may take comfort from noting that money is being spent on their local hospitals and consequently may wonder how services could be terminated or reduced. Monaghan General Hospital has never had so much money spent actively on it as at present. A total of €4.5 million is being spent to refurbish two wards and Monaghan General Hospital has a state-of-the-art accident and emergency department. At present, it has 24-hour accident and emergency services with medical cover seven days a week. It is proposed to replace this with 12-hour nurse-led cover seven days a week. Moreover, its X-ray department service, which operates on a 24-hour basis seven days a week will be replaced with a day service. The high care unit will be moved, first, to Cavan and eventually to Drogheda and acute beds will be removed.

The Health Service Executive states that the hospital will have a residential component. This is new phraseology that means a step-down facility or, if one prefers, an upgraded nursing home. This is what people claim to be a better and safer service, although no new service will be put in its place. On any given day on which a trolley count is performed, counties Cavan and Monaghan will have more than 20% of the national trolley count. The staff in both hospitals are worked into the ground and are absolutely demoralised. Someone should re-examine what constitutes a better and safer service. While I know that services must be upgraded, there is a role for smaller hospitals. They should be allowed to play that role in the delivery of health care services.

Mr. Gregory

I support the motion to put patient safety at the heart of the health services. I want to use my time to draw attention to an issue of patient safety, albeit not in the context of a social care facility.

Recently, one of my constituents began to lose the sight in her eyes. Using her medical card, she attended her GP, who advised her to see a specialist as quickly as possible. The GP wrote to the Mater hospital on her behalf and she then tried to make an appointment. She was told there was a long waiting list and that she might not be reached until October 2007.

This alarmed her greatly as her eyesight was deteriorating rapidly. She contacted my office and I tried to assist her. However, not even the National Treatment Purchase Fund could secure an appointment for her. The reality was that as she was on a low income and had a medical card, she would be obliged to wait irrespective of the urgency of her condition. This lady waited for a number of months to no avail. She then arranged to borrow the necessary money, contacted the Mater Private Hospital and was then able to make an immediate appointment. The consultant confirmed the seriousness of her condition and made arrangements for the necessary treatment with his team. The moral of the story is that at present, if one is on low pay and has a medical card in Ireland, under the Government's two-tier health service one can go blind while waiting for treatment. However, if one has the money, one can receive such treatment immediately.

In a follow-up parliamentary question, I asked the Minister to arrange for the HSE to reimburse my constituent with the several hundred euro she had borrowed and that she was obliged to pay to secure the initial appointment. This was bluntly refused by the Minister in her reply to the Dáil. This constitutes inequality, Progressive Democrats-style, in this House and it can only be addressed by political change in this State.

Mr. O’Dowd

This is a very important debate and I welcome the proposal by Fine Gael and the Labour Party. I congratulate Professor O'Neill for producing an excellent report which makes very harrowing reading. He has done a tremendous public service to the State, and in particular to elderly people. His report is a damning indictment of the political and health systems, the HSE and the Department of Health and Children, which repeatedly failed to act despite knowing what was going on.

I call on the Minister to launch an inquiry into Bedford House nursing home in Balbriggan. Bedford House is similar to Leas Cross in that the HSE transferred patients from St. Ita's Psychiatric Hospital in Portrane to it at the same time that it transferred patients to their deaths in Leas Cross. The decision by the HSE to transfer these patients to these two nursing homes is a very serious issue. It is interesting that the HSE chose to transfer patients to a nursing home owned by a doctor, namely, Dr. Nasser. The facts are that this nursing home, Bedford House, was in a most shameful and disgraceful condition while this process was ongoing.

I will give the House some idea of what was taking place at Bedford House. A routine inspection took place on 19 February 2004. Regarding physical condition, the report concluded that the inside of the nursing home appeared very rundown. It found that the window curtains in five of the bedrooms were falling off and could not be closed. There was no screen between any of the patients in room 17, a four-bedded room upstairs. The four men in this room used commodes for toileting. The report found that in room 23, which was occupied by two patients, the curtain screen rail and curtain were on the floor and the patients' clothes were strewn over the curtain. In addition, the curtain was off the window rail and the light over the bed was not working. The report then went on to detail how emergency call bells were not working, how a bedside locker in one room was unsteady, how the door was falling off another and how the linoleum floor covering was replaced in two rooms upstairs but the old covering was left in a pile outside the front of the building.

In respect of hygiene, the report found that patients were given a bath or shower once every ten days. It found that in the sluice room downstairs, the toilet was used by patients but there was no wash hand basin and the sluice did not have a wide outlet. There were two baths in the nursing home but the one upstairs was not used. There were seven showers but only four were used and they had not been cleaned, while there were 12 toilets and one of these was being fixed. The report found that in the bathroom between bedrooms 3 and 4, the floor was dirty and the commode pan was not emptied. The floors were dirty in some of the other bathrooms and cleaning was in progress. When seats were lifted on a number of commodes, they were found to be dirty. Some beds were only half made as clean linen was unavailable and some of the vacant beds were not made up.

I have a copy of a letter of complaint from a woman whose father was a private patient of Bedford House. I will try not to identify the man in question by age. The letter complained that he had to take four stairlifts to his bedroom which was situated at the top of the nursing home. As a result, he could not go to bed when he wished and was obliged to wait for the night staff after 8 p.m. The letter went on to state that:

He shares a bedroom with another man, both of whom use commodes at night and the bedroom carpet is filthy. I find now that the day room smells of urine, which is totally unacceptable as it is both unhygienic and unhealthy. The chairs in this room are never cleaned.

My father has been in this home since August 2003 and has had the best of treatment from the staff but lately the staff numbers have been cut to a minimum and the patients are being hurried and not enough time or attention paid to them. For the past week to ten days the television is out of action — the patients have nothing else — and the answer is always the same that they are fixing it tomorrow.

She then goes on to complain about the standard of food at the nursing home. She concludes by stating that she is not sure of the solution to these problems as the bedroom is the only one available to her father due to the fact while he was in hospital for tests in October 2003, his room was given away as patients were being taken in from St. Ita's in Portrane.

This is the type of nursing home to which the HSE delivered patients. Shameful and disgraceful as Leas Cross was, this particular nursing home, to which patients from St. Ita's were transferred, is much worse. I am calling for an investigation into all aspects of the management of this home. It is interesting to note that the nurse in charge of this nursing home had an unusual duty. She was running another nursing home at the same time, something that is forbidden by law, and appears to have done so for a period of up to nine months. The health board knew about this because I am reading this from its reports. Nothing has changed since the activities at Leas Cross and Bedford House were highlighted because the law has not changed and offers no protection to patients.

I have a letter of complaint from another individual relating to the same nursing home. It states the general cleanliness of the home was undesirable, the bathrooms were smelly, excrement was dug into the floors, residents were not showered or bathed, there was a lack of supervision and some residents were not dressed in the morning and hence left in their bed clothes all day. The letter says glasses from which patients had to drink were unwashed and filthy, that they were left out of reach of patients and shared among patients and that patients did not know which drinks were their own and drank other patients' drinks. The letter goes on and on.

At the end of it all is one Government, one Minister and the HSE, which have completely avoided accountability in the Dáil. I heard the Taoiseach speak about the matter yesterday and today in the Dáil. He has some cheek to think he can get away with it. He might get away with many things but he will not get away with this because the people will not allow it. They expect better from the Minister, the Department, the HSE and the medical profession. Imagine a doctor owning the nursing home in question. I wonder what the Medical Council thinks of it.

The strangest thing is that the inspectors who were responsible for the inspection of this nursing home also inspected Leas Cross and have now been employed by the HSE in a private capacity to provide consultation in respect of an inspection regime for private nursing homes. The entire system is rotten from top to bottom. This Government has failed disgracefully in vindicating the rights of patients but worse than this, it transferred the most vulnerable elderly patients from St. Ita's to Leas Cross and Bedford House where many of them died in disgraceful conditions.

There is a difference here between public and private patients and between people who have a psychiatric illness and those who do not. The Minister of State at the Department of Health and Children, Deputy Tim O'Malley, read a report from the European Commission that inquired into the torture and mistreatment of patients in the EU. These are people who are abused while they are in the hands of the State in an involuntary capacity. The Minister of State will stand charged before the next visit of that committee to Ireland because he delivered these unfortunate people, many of whom have since died, into the hands of the same nursing home owners who treated them disgracefully. The Minister of State knows this because he has read its last report and was a Minister of State when it was delivered. The medical profession has stood by and participated in it, as has the nursing profession, the HSE and the HSE inspectors. That is what we are living with and that is what this Government is providing to people.

Other substandard nursing homes exist. A list of 12 such homes produced in 2001 was given to me by the HSE. An inquiry should be launched into each of these homes. I will not discuss them tonight as I do not have sufficient time, but one of them was run by a Montessori teacher who had no medical training. For many months, she was the manager of a nursing home, about which she knew nothing. Strange as it may seem, although it may not seem strange at all, patient records from this nursing home were put into a skip and burned so that when inquests were held, no records could be found.

I received a complaint last week from an undertaker who said he took possession of a body which was in an appalling condition from a nursing home. He stated he had never seen anything like the condition of this body, which he said was covered in faeces, including the fingernails. He could not believe it. I also received a complaint last week concerning another nursing home from a person who said that when regular staff are off work at weekends, young people work in the home and leave the elderly patients in their own bodily fluids and faeces all night and that when the woman returns after the weekend, patients' bodies are literally caked in faeces. That is true, and that is what is going on. The Government cannot shy away from that. The Minister has done nothing about it. She stands charged before the court of public opinion. The Government has failed in the most important respect, namely, to protect the most vulnerable people in our community, our elderly.

I acknowledge the Minister of State, Deputy Brian Lenihan, is doing his best to provide for the needs of children, but at the other end of that scale are people who are closer to leaving this world. It is sad to recall that in one home the prayers of the dying are not read as a resident dies. I will be happy to give the Minister of State the name of that home following this debate. Nothing has changed, which is the saddest aspect of all, and nothing will change until we come into Government when we will make sure that this changes.

Mr. S. Ryan

I am pleased to have this opportunity to make a contribution on the need to establish a patient safety authority and to put patient safety at the centre of our health service. Unfortunately to date, this has not been the case.

In recent times there has been a litany of shocking revelations about deficiencies in our health service to such an extent that public confidence in it has been undermined. In the short time at my disposal I wish to address the litany of revelations in respect of Leas Cross.

The Leas Cross report, which had to be dragged out of the Department of Health and Children and the Health Service Executive, is one of the most damning reports in the history of this State. The Government, the health boards and the medical profession must be condemned for the systematic failure that led to the mistreatment of elderly people in the Leas Cross nursing home. The most startling aspect of this shameful episode is that the Government and authorities could and should have intervened earlier to have the Leas Cross nursing home investigated and closed.

I will elaborate on why I say that. In 1994, well before the "Prime Time Investigates" programme on Leas Cross, a range of problems were identified by the inadequate inspectorate system, which we now have in place, and brought to the attention of the Department of Health and Children and the health boards regarding the deficiencies in nursing care in nursing homes not only in Leas Cross but throughout the length and breadth of the country. The range of problems identified at that time included staffing levels and nursing policy issues, maintenance and accommodation standards, hygiene problems, lack of incentives for residents, poor record keeping, insufficient or no active involvement from the local authorities on fire safety issues, lack of equipment and appropriate clinical practices, for example a lack of pressure mattresses, and discrepancy in the contract of care. These issues were well known to the Minister and her junior Ministers with responsibilities in this area.

I am aware of a submission to Professor O'Neill in respect of the death of a 91 year old relative of a constituent of mine, who first entered Leas Cross in December 2002 and who died in 2004. Among the issues raised were: the patient was injured and knocked to the floor on numerous occasions; the 91 year old man lay in bed for three days with a broken hip before being seen by a doctor; when he was eventually brought to Beaumont Hospital the doctor who admitted him said this elderly man was suffering from malnutrition when he arrived in the hospital; and his death certificate was not registered as required. All these issues were raised with the health board at the time.

Over the years I have raised with the senior officials of the health boards the policy of transferring residents from the loving homely environment in St. Ita's to private nursing homes and I question the criteria, need and justification for this policy. After reading Professor O'Neill's report, it is obvious the care of the residents of St. Ita's who were transferred was not the main priority. There was another agenda — senior management had to be seen to implement a policy of moving patients from St. Ita's, irrespective of the consequences.

People with intellectual disabilities have no one to speak for them and therefore it is important that I place on record some of the facts that were brought to the attention of the officials of the health board as far back as 2003. If the officials of the health board knew about them, the officials of the Department of Health and Children also knew about them. A consultant in old age psychiatry raised the need to follow up patients transferred from St. Ita's Hospital to Leas Cross. A further letter, within two weeks, from two senior consultants also referred to a need for follow up services. They particularly drew attention to the fact that three of the initial group of 14 patients discharged to Leas Cross had been referred fairly quickly to Beaumont Hospital as being seriously ill. Nursing care appeared to have been the issue in all these cases. The last two patients had arrived with bronchial pneumonia and one was suffering from dehydration. These concerns were brought to the attention of the director of the nursing home inspectorate team on 9 January 2004. These consultants also pointed out that seven deaths had occurred since the transfer of the patients on 3 September, and three of them occurred over the Christmas period. This damning letter was circulated to everyone within the system and we are told that nobody knew anything about it and nobody was responsible.

Professor O'Neill's report states that a memo exists of issues discussed with the director of nursing of Leas Cross following a visit to Leas Cross nursing home in July 2004. The consultant highlighted the main concern was lack of qualified staff, auxiliary staff and basic nursing care to meet patients' needs. She also noted a lack of stimulation, occupational therapy and supervision. Four of the former St. Ita's patients — many of whom I knew to see because I live in Portrane and I used to visit patients there who were cared for in a loving, caring environment — were sitting in wheelchairs and others in old Buxton chairs. Generally, personal hygiene was poor. That was never the case in St. Ita's where these patients were looked after and minded for years. Clothes were grubby in appearance and a few patients had a strong odour of incontinence. Staffing appeared inadequate with only one qualified staff nurse and nine care staff caring for 65 residents in one area and one qualified staff nurse and four attendants for approximately 40 residents in another area. These concerns were also expressed to many of the senior people in the Department and the health boards.

A further matter of concern raised by the consultant psychiatrist was that the group with dementia as a primary diagnosis had a high mortality rate in Leas Cross. The admissions that were transferred to hospitals were characterised as suffering from dehydration, pneumonia and skin care problems raising concerns over adequacy of care. I could go on and list further concerns.

This is the reality of lack of care and attention given to some of the most vulnerable people in our society. We are charged with looking out for those people and Ministers and officials in the health boards have responsibility for the care of people with intellectual disability. What were they doing in arranging for these patients to be taken out of hospital and put into a nursing home, knowing what was going on? Did they do anything about it? No, they kept their heads down.

What are we told about this report? Nobody is responsible and nobody is prepared to put up their hands and say there was a mistake, there was an error.

It is painfully obvious that the Minister, the Department and the health boards simply turned a blind eye to these problems and as a result elderly people and people with intellectual disabilities, who are among the most vulnerable in our society, suffered appalling conditions and treatment in Leas Cross. This is an indictment of the failure of the Government's policy in this area over the years. We do not have a clear and transparent set of rights and entitlements for older people and their families. We do not have a system which ensures quality care is delivered. We do not have a fair and equitable system for financing care. With all the money available to it, this Government failed in its commitment to provide 800 public nursing home beds for the most vulnerable in our society. In my area of north Dublin people in need of public nursing homes will be dead years before their time. It is up to the Government to take responsibility and look after the most vulnerable in our society.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I listened to the debate this evening and I thank those Deputies who contributed. The Government is committed to ensuring high quality care is available to all patients and to the further development of the health services, in particular, addressing issues of patient safety.

Last night, it was stated that insufficient funding was provided. No Government has provided more funding to these services than the present one. A total of €110 million was provided this year for older persons in palliative care with an additional follow-on of €40 million for next year. This investment was the largest increase ever provided for older persons in palliative care. The total expenditure in the Department on services for the elderly this year was €1.2 billion.

Last night, it was stated that more support should be made available for the cost of nursing home care borne by individuals and their families. New funding arrangements for persons in nursing homes will be finalised by the Department of Health and Children in line with the commitments given in the partnership agreement Towards 2016. These arrangement will apply irrespective of whether a person is in a private or public facility. The new arrangements will propose co-payments by care recipients, based on a national standardised financial assessment, a principle also agreed by the Government.

A working group was established by the Department to review the standards last set down in 1993 for residential care settings for older persons. Membership of the group comprised officials from the Department, the Health Service Executive, the social service inspectorate and the Irish Health Service Accreditation Board. The group was involved in developing draft standards of both public and private residential care for older people. These draft standards will be circulated shortly to interested parties for consultation.

The Irish Health Service Accreditation Board examined the development of accreditation standards. These will be introduced when the national standards are in place. This board and the Department are involved in ongoing consultation on national accreditation standards.

It is a matter of public record that the HSE working group report on nursing home inspection and registration was completed in July. The executive's approach to nursing home inspection was strengthened in light of the report. One of the recommendations was the recruitment and establishment of dedicated national inspection teams which would include medical, nursing and mental health professionals and have access to other professionals as required.

All teams carry out inspections using a common approach based on a standard check list. Inspections were on an unannounced basis for the past 12 months. The transparency of the entire system is ensured by making reports available to the public. It was suggested in the media that one arm of the HSE continues to place public patients in nursing homes which are found to be substandard by the HSEs own inspection regime. I assure the House this is no longer the case.

The health Bill will be published before the end of the year and will establish the Health Information and Quality Authority on a statutory basis. It will be an independent body, incorporating the office of the chief inspector of social services. Reliable and accurate information on what is happening in our system is a critical prerequisite to effective action. We must improve our data collection, analysis and results dissemination and share information on preventing clinical error across our health services. The authority's role on information will also be a key driver of the quality and patient safety agenda.

I assure the House the Government is fully committed to ensuring patient safety is central to health policy and legislation. Significant steps were already taken to ensure improvements in this area. All steps necessary will continue to be taken to ensure real and lasting improvements in patient safety. The Government has done a considerable amount of work to progress the patient safety agenda.

The HSE provides centralised planning, which enables one area to more easily learn from another and best practice to spread. It provides national leadership in quality and risk management across hospitals and primary and community care. The clinical indemnity scheme brings together valuable information on incidents and valuable lessons can be learned from this.

The Department put considerable effort into developing standards of care for older persons and the HSE implemented new management structures to facilitate safety. Through the Health Information and Quality Authority, the Government will put in place another major element of an independent standards regime. All of the elements I mentioned will combine to form a robust and effective patient safety infrastructure.

Mr. Ring

The reason I wish to speak on this issue is because I raised it on many occasions when I was my party's deputy spokesperson for health in 1999, including with the then Minister of State, former Deputy Tom Moffatt in October of that year. Deputy Gay Mitchell and I also raised it in a Private Members' motion. I stated then and I will state now that expensive visiting committees go to prisons to protect the rights of prisoners who committed murder, rape, assault and abuse but no inspectorate is in place for nursing homes.

The people to blame for Leas Cross are the Minister and former Minister for Health and Children and the officials in the Department. They knew about it and they were told about it. What really makes me angry is when I raised the issue of a public nursing home in Belmullet, the best the Department of Health and Children could do was to have an open day. I went there and saw an elderly woman up against a wall down which water was dripping. After I raised the issue, a sum of €1 million was made available by the Western Health Board to repair it.

The health board thought it would cover it up by bringing in the then Minister of State, former Deputy Moffatt, and the media. They did not cover it up. Leas Cross was not covered up because it was a scandal waiting to happen. If we had accountability in this country the Minister for Health and Children and the former Minister for Health and Children would be out the door. Two Ministers resigned in Sweden, one because she did not pay her television licence and the other because she did not pay tax for employing a nanny. However, we let our elderly be abused. The health board, the Ministers and the Government knew it. On many occasions in 1999, I spelled it out. Report after report and Minister after Minister stated something would be done. Many other Leas Cross situations exist throughout the State. It is wrong. If it happened in a Third World or any other country, the Opposition would ask the Minister for Foreign Affairs to bring in the ambassador for that country and state to him or her we could not allow it to happen. However, it is okay to abuse our own elderly.

This has gone on too long. I want to see the legislation introduced immediately. I want to see an inspectorate put in place and officers going into public and private nursing homes to ensure our loved ones, some of whose parents died for this country, get the best protection from the State. The Government knew about this in October 1999, 2000 and 2001. If accountability existed in the country, two or three Ministers would resign. They should do the honourable thing. We would not have as much abuse in this country if they did their jobs.

Dr. Twomey

We stated last night that no Minister showed sufficient respect to elderly people to bother turning up at the HSE press conference last Thursday. Now, we see the same Ministers cannot bother to stay in the Dáil Chamber to hear what the Opposition has to state about the Leas Cross report. This is the type of arrogance creeping into the Government which makes it disrespectful to the people it is supposed to represent.

I thank all Deputies who contributed to the debate. I recognise the great work done by families, care assistants, doctors, nurses, private nursing homes and administrators in the HSE who care about patients. When I commented on the HSE tonight, the people I am referring to know who I am talking about — it is not everybody in the HSE but a small cohort who more or less colluded with Ministers, as Deputy Ring said, over the past nine or ten years in keeping elderly people in terrible conditions in a small minority of nursing homes and letting people get away with it.

It seems that there is no end to the scandalous fallout from the Leas Cross affair. Today, it was revealed that 14 months after the "Prime Time" programme and 20 months after Martin Hynes had seen and reported on the poor treatment of residents in Leas Cross, nothing has changed in the inspection of nursing homes. Absolutely nothing has changed so what does it take to wake up the Government? There is no doubt that both the Government and the HSE have been left with zero credibility as regards looking after the elderly, given what we have seen in the past couple of weeks.

The Government's amendment in response to Fine Gael and Labour's motion for the urgent creation of a patient safety authority is a damning indictment of its failure. The amendment shows up the Government's incompetence, which is unbelievable. There are 14 points in the Government's amendment and those dealing with patient safety or setting standards in the health service are either non-existent or have been in a need-to-do category for at least five years. I doubt whether too many members of the Fianna Fáil Party have read those points, but if they did they would find they are not currently part of the health care service.

I will take one example to demonstrate why we should not longer believe the Government cares about elderly people. The Neary scandal in Our Lady of Lourdes Hospital was exposed in 1998 but even today, as we speak in this Chamber, we have no competence assurance for doctors, no new medical practitioners Bill and no HIQA legislation, which includes the social services inspectorate. All of these things were promised before the last election. This week, just like last year when this scandal was exposed in the "Prime Time" programme, which struck a deep chord with the general public, they were all promised again. This is totally unacceptable to the public. The Government has refused to accept the very things on which it was asked to make recommendations.

It gets worse, especially when we deal with the recommendations of the report by Judge Harding-Clark on Our Lady of Lourdes Hospital. Yesterday, the Minister, Deputy Harney, told the House that things had improved dramatically with regard to the recommendations in the judge's report on Our Lady of Lourdes Hospital. However, neither the Minister, her officials, the HSE nor, to the best of my knowledge, the hospital itself have any action plan to deal with the report's recommendations, which is completely contrary to what the Minister said last night. She has done nothing to implement those recommendations. In fact, and this can be confirmed by the HSE, Our Lady of Lourdes Hospital is short 40 staff nurses and midwives. The hospital where this crisis started and which led to the Neary report is now short of staff nurses and midwives. It is back in crisis again, where it all began. The Government cannot seem to get it right when it comes to protecting patients.

This morning, I took part in RTE's "Morning Ireland" programme. On the same programme Mr. Aidan Brown represented the HSE and tried to provide the type of reassurances we have come to expect from the Government and the HSE. It is the type of reassurance people probably got on the Titanic. It was so half-hearted it was a disgrace. He was trying to tell us that proper inspections are now being carried out but he was caught out before. Since the day the HSE was established we have been told that things will get better. A year later, “Prime Time” exposed the fact that matters are getting worse. The HSE may apologise but its gets caught again for not improving the inspection regime.

Mr. Brown tells us that things are getting better but I have been made aware that in the past three months, nursing home inspections were carried out for the HSE with no doctor or nurse present. After all that has happened in the past, that is the type of inspection report Mr. Aidan Brown is trying to convince the people of Ireland is adequate in this day and age.

The Minister of Health and Children also spoke about standards of care being promoted by the Irish Health Service Accreditation Board. Most people will not be familiar with that board. Last November, the Minister received standards that were drawn up by this board. I would like to know if those standards have been published and, if so, are they being used? I believe, however, that they have not been published one year after they were received by the Minister for Health and Children. Therefore, the very elements, which the Minister is telling us are making things better, are not actually being implemented. We do not have HIQA or the social services inspectorate to protect nursing homes. In addition, we are not using the Irish Health Service Accreditation Board's standards. Nothing to which the Minister referred is being used.

Item 12 in the Government's amendment to the motion "notes that the Minister for Health and Children will introduce regulations in early 2007 which will set out a statutory framework for the introduction of a complaints process throughout the HSE". If there was ever a perfect example as to why Fine Gael and Labour's patient safety authority needs to be established urgently, this is it. Two years after the establishment of the HSE, the Minister has not drawn up the set of regulations under which patients could make complaints. The Minister in charge has not introduced a process whereby patients can make complaints about the HSE. This is incompetent. I know that some people may not understand what corporate governance is but surely Ministers, who have been in power for almost a decade, understand the most basic things about it. This is absolutely ridiculous.

Another issue has cropped up with regard to the report on the death of Mr. P. J. Walsh. We have seen no improvements in the service in the north east, but I will deal with that matter at the Committee on Health and Children tomorrow. The recommendations of the inquiry into Our Lady of Lourdes Hospital have not been implemented by the Government either.

I now turn to the case of Mr. Peter McKenna. The House will be aware that Mr. Martin Hynes, who appeared on television last week to discuss this issue, wrote the report on Mr. Peter McKenna in 2000. It concerned a patient who was treated disgracefully in Leas Cross, yet those responsible still sent patients in there. They were being sent to their doom and those responsible did not care. Leas Cross is a shocking indictment of the Government's incompetence and arrogance. As Deputy Ring said, at least one Minister should resign to show that the Government has some respect for the people it claims to represent. The actions of those concerned are both shameful and disgraceful.

The failure to provide a funding policy for future care of the elderly is another aspect of this problem. The Government has no problem pushing through legislation to force elderly people to sell their homes, but it has no respect for patients when it comes to their future care.

Some of the Government's representatives here obviously do not have a clue what is going on. HIQA is not better than the Fine Gael and Labour proposals. To the best of my knowledge, HIQA does not apply to private hospitals. The Progressive Democrats are trying to build more private hospitals even though there is currently no set of standards to protect patients. Therefore, what the Progressive Democrats claim they will establish, with their lap-dogs in Fianna Fáil, will not even apply to private hospitals. In some respects, HIQA is the Irish version of the National Institute for Health and Clinical Excellence in the UK. Recently, the latter body tried to deny UK cancer patients a drug because it cost too much. The HIQA proposal is all about costs, processes and evaluation. It does not put the patient at the centre of focus for the health care services. The Government has really lost touch with the sort of people it is supposed to be representing. That is why it gets wrapped up in processes, evaluation and all that old nonsense.

Mr. Ring

That is right.

Dr. Twomey

The Government has forgotten what patients are all about. HIQA has no advocacy process, which is part of our proposed patient safety authority. It has no whistle-blower legislation either. Deputy Fiona O'Malley said that Fine Gael and Labour are unambitious. Having achieved nothing itself, it is saying that our proposals are unambitious. That is rich coming from a Government putting forward points to justify its care of patients, which remain unimplemented or non-existent. She suggests our proposal is unambitious.

Fine Gael and the Labour Party's proposal relating to a patient safety authority is practical, realistic and will ensure the patient is central. When Deputy Fiona O'Malley said this proposal was unambitious the image entered my mind of Marie Antoinette suggesting the poor of Paris should eat cake when told of their hunger. It seems Deputy O'Malley has a similarly poor connection with the people she represents. The Government has completely lost touch with the elderly people it represents. Fianna Fáil Deputies need to wake up because they always claim to represent the poor and oppressed in Irish society, but it seems ten years in power has erased such sentiments. Perhaps they now feel the little people no longer matter and the cost of keeping elderly people is higher than their human value. That is the way the Government is treating them. I am happy to move this motion and I would like to see the Fianna Fáil Deputies come into the House to show how much they disrespect their elderly constituents.

Mr. Curran

We do not disrespect them.

Amendment put.

The Dáil divided: Tá, 71; Níl, 58.

Tá

• Ahern, Dermot.
• Ahern, Noel.
• Ardagh, Seán.
• Blaney, Niall.
• Brady, Johnny.
• Brady, Martin.
• Browne, John.
• Callanan, Joe.
• Callely, Ivor.
• Carey, Pat.
• Cassidy, Donie.
• Collins, Michael.
• Cooper-Flynn, Beverley.
• Coughlan, Mary.
• Cowen, Brian.
• Cregan, John.
• Cullen, Martin.
• Curran, John.
• Davern, Noel.
• de Valera, Síle.
• Dempsey, Tony.
• Dennehy, John.
• Devins, Jimmy.
• Ellis, John.
• Finneran, Michael.
• Fitzpatrick, Dermot.
• Fleming, Seán.
• Fox, Mildred.
• Gallagher, Pat The Cope.
• Grealish, Noel.
• Hanafin, Mary.
• Haughey, Seán.
• Hoctor, Máire.
• Jacob, Joe.
• Keaveney, Cecilia.
• Kelleher, Billy.
• Kelly, Peter.
• Killeen, Tony.
• Kirk, Seamus.
• Kitt, Tom.
• Lenihan, Brian.
• Lenihan, Conor.
• McDowell, Michael.
• McEllistrim, Thomas.
• McGuinness, John.
• Martin, Micheál.
• Moloney, John.
• Moynihan, Donal.
• Moynihan, Michael.
• Mulcahy, Michael.
• Nolan, M. J.
• Ó Cuív, Éamon.
• Ó Fearghaíl, Seán.
• O’Connor, Charlie.
• O’Dea, Willie.
• O’Donnell, Liz.
• O’Donovan, Denis.
• O’Flynn, Noel.
• O’Keeffe, Batt.
• O’Keeffe, Ned.
• O’Malley, Fiona.
• O’Malley, Tim.
• Parlon, Tom.
• Power, Peter.
• Sexton, Mae.
• Smith, Brendan.
• Smith, Michael.
• Treacy, Noel.
• Wallace, Mary.
• Wilkinson, Ollie.
• Wright, G. V.

Níl

• Boyle, Dan.
• Breen, James.
• Breen, Pat.
• Broughan, Thomas P.
• Connaughton, Paul.
• Connolly, Paudge.
• Costello, Joe.
• Cowley, Jerry.
• Crawford, Seymour.
• Crowe, Seán.
• Cuffe, Ciarán.
• Deasy, John.
• Deenihan, Jimmy.
• Durkan, Bernard J.
• Enright, Olwyn.
• Ferris, Martin.
• Gilmore, Eamon.
• Gogarty, Paul.
• Gormley, John.
• Gregory, Tony.
• Hayes, Tom.
• Healy, Seamus.
• Hogan, Phil.
• Howlin, Brendan.
• Kehoe, Paul.
• Kenny, Enda.
• McCormack, Pádraic.
• McEntee, Shane.
• McGinley, Dinny.
• McGrath, Finian.
• McGrath, Paul.
• McHugh, Paddy.
• McManus, Liz.
• Mitchell, Olivia.
• Moynihan-Cronin, Breeda.
• Murphy, Catherine.
• Murphy, Gerard.
• Noonan, Michael.
• Ó Caoláin, Caoimhghín.
• Ó Snodaigh, Aengus.
• O’Dowd, Fergus.
• O’Keeffe, Jim.
• O’Shea, Brian.
• O’Sullivan, Jan.
• Pattison, Seamus.
• Penrose, Willie.
• Quinn, Ruairí.
• Rabbitte, Pat.
• Ring, Michael.
• Ryan, Eamon.
• Ryan, Seán.
• Sherlock, Joe.
• Shortall, Róisín.
• Stagg, Emmet.
• Stanton, David.
• Timmins, Billy.
• Twomey, Liam.
• 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: Tá, 71; Níl, 58.

Tá

• Ahern, Dermot.
• Ahern, Noel.
• Ardagh, Seán.
• Blaney, Niall.
• Brady, Johnny.
• Brady, Martin.
• Browne, John.
• Callanan, Joe.
• Callely, Ivor.
• Carey, Pat.
• Cassidy, Donie.
• Collins, Michael.
• Cooper-Flynn, Beverley.
• Coughlan, Mary.
• Cowen, Brian.
• Cregan, John.
• Cullen, Martin.
• Curran, John.
• Davern, Noel.
• de Valera, Síle.
• Dempsey, Tony.
• Dennehy, John.
• Devins, Jimmy.
• Ellis, John.
• Finneran, Michael.
• Fitzpatrick, Dermot.
• Fleming, Seán.
• Fox, Mildred.
• Gallagher, Pat The Cope.
• Grealish, Noel.
• Hanafin, Mary.
• Haughey, Seán.
• Hoctor, Máire.
• Jacob, Joe.
• Keaveney, Cecilia.
• Kelleher, Billy.
• Kelly, Peter.
• Killeen, Tony.
• Kirk, Seamus.
• Kitt, Tom.
• Lenihan, Brian.
• Lenihan, Conor.
• McDowell, Michael.
• McEllistrim, Thomas.
• McGuinness, John.
• Martin, Micheál.
• Moloney, John.
• Moynihan, Donal.
• Moynihan, Michael.
• Mulcahy, Michael.
• Nolan, M. J.
• Ó Cuív, Éamon.
• Ó Fearghaíl, Seán.
• O’Connor, Charlie.
• O’Dea, Willie.
• O’Donnell, Liz.
• O’Donovan, Denis.
• O’Flynn, Noel.
• O’Keeffe, Batt.
• O’Keeffe, Ned.
• O’Malley, Fiona.
• O’Malley, Tim.
• Parlon, Tom.
• Power, Peter.
• Sexton, Mae.
• Smith, Brendan.
• Smith, Michael.
• Treacy, Noel.
• Wallace, Mary.
• Wilkinson, Ollie.
• Wright, G. V.

Níl

• Boyle, Dan.
• Breen, James.
• Breen, Pat.
• Broughan, Thomas P.
• Connaughton, Paul.
• Connolly, Paudge.
• Costello, Joe.
• Cowley, Jerry.
• Crawford, Seymour.
• Crowe, Seán.
• Cuffe, Ciarán.
• Deasy, John.
• Deenihan, Jimmy.
• Durkan, Bernard J.
• Enright, Olwyn.
• Ferris, Martin.
• Gilmore, Eamon.
• Gogarty, Paul.
• Gormley, John.
• Gregory, Tony.
• Hayes, Tom.
• Healy, Seamus.
• Hogan, Phil.
• Howlin, Brendan.
• Kehoe, Paul.
• Kenny, Enda.
• McCormack, Pádraic.
• McEntee, Shane.
• McGinley, Dinny.
• McGrath, Finian.
• McGrath, Paul.
• McHugh, Paddy.
• McManus, Liz.
• Mitchell, Olivia.
• Moynihan-Cronin, Breeda.
• Murphy, Catherine.
• Murphy, Gerard.
• Noonan, Michael.
• Ó Caoláin, Caoimhghín.
• Ó Snodaigh, Aengus.
• O’Dowd, Fergus.
• O’Keeffe, Jim.
• O’Shea, Brian.
• O’Sullivan, Jan.
• Pattison, Seamus.
• Penrose, Willie.
• Quinn, Ruairí.
• Rabbitte, Pat.
• Ring, Michael.
• Ryan, Eamon.
• Ryan, Seán.
• Sherlock, Joe.
• Shortall, Róisín.
• Stagg, Emmet.
• Stanton, David.
• Timmins, Billy.
• Twomey, Liam.
• Wall, Jack.

Tellers: Tá, Deputies Kehoe and Stagg; Níl, Deputies Kitt and Kelleher.

Question declared carried.