Speech by Mr Sean Power T.D. Minister of State at the Department of Health and Children – Private Members Motion 31 May 2005

I welcome the opportunity to address the House on this important and very emotive issue. I was extremely concerned by the findings of the Prime Time Investigates programme last night. It is unacceptable that older people should be subjected to the type of environment portrayed by the programme am pleased that the Health Service Executive has reached agreement with the owners of the Home to bring much needed improvement into the operation of the facility. The following is the agreement arrived at earlier today:
1.The Health Service Executive Northern Area will be assigning a Director of Nursing and senior nursing staff to ensure the delivery of the highest standard of patient care in Leas Cross on a 24 hour basis.
2.A Clinical Governance Steering Committee is being established. This will be multi-disciplinary and will also involve a representative of the residents/families and an independent expert. The Steering Committee will oversee implementation of all recommendations as above.
3.An Independent Inquiry Team is being established to investigate all areas of concern.
4.The HSE Northern Area will be exploring all options regarding the future management of the Home.   Policy is to maintain older people in dignity and independence in their own homes, and in accordance with their wishes, for as long as possible and to provide a high quality of long-term residential care for older people when this is no longer possible.

It should be remembered that it is internationally recognised that only 5% of the older population will need long-term care. However, people are generally living longer lives these days, and even though most are leading health independent lives, the actual number of people in need of long-term care is increasing. There is huge demand on public long-stay places, and these days there is a growing reliance in using private nursing home places.

The nursing home sector is governed by the Health (Nursing Homes) Act 1990 and subsequent regulations. The Nursing Home (Care and Welfare) Regulations, 1993 set out the standards which the private nursing home sector must adhere to for the purpose of registration under the Health (Nursing Homes) Act, 1990. The Regulations only apply to the private nursing home sector and do not cover public long-stay facilities for older people.

However there was a commitment in the Health Strategy ‘Quality and Fairness – A Health System for You’ to extend the remit of the Social Services Inspectorate to other social services, including residential services for older people.

The Social Services Inspectorate will be established on a statutory basis and will be independent of the Health Services Executive. Its work will cover both public and private nursing homes and the Bill will be published later this year.

In addition the Department of Health and Children are urgently reviewing the operation of the 1990 Nursing Homes Act and the Nursing Home Regulations 1993 to strengthen the powers available to the Health Service Executive. This will be a wide ranging review which will have the rights of the patient as the centre of its work. It will update the Nursing Homes Act and Regulations so that any issues in relation to employment law, training of staff etc are reflected in the new legislation. Again it is my intention to have this Bill published this year so that we can have an early debate will all stake holders on a new framework for all patients in nursing homes.

In regard to information, I regard this as one of the most critical issues to be covered by the Bill. In this day and age it is simply not satisfactory for people not to have comprehensive information easily available on services being provided in nursing homes. I will ensure that the new Bill will include in it a specific provision for easy access by the public to inspectors reports on nursing homes; I understand that under the current legislation this is not possible.

I am aware that the HSE will be developing as a mater of priority a common national approach to the inspection of nursing homes. This work will be facilitated by the fact that the HSE as a national agency, can more easily implement a common policy than the previous situation where we had ten Health Boards and the Eastern Region Health Authority. The work can be a useful prelude to the establishment of the Social Services Inspectorate on a statutory basis and the application of common standards of inspection.

The Government’s commitment to the development of a comprehensive range of services for older people can clearly be demonstrated by outlining the resources made available in recent years for service developments. Since 1997 additional spending on health care services is in excess of €302m (to 2005 inclusive).

In 2004, a total of €9.5 million in additional revenue funding was allocated to services for older people and for 2005, this figure is being increased to €15.228 million. This funding will be used for a variety of services including:
•Nursing Home Subvention Scheme
•Home Care Grants
•Home Help Service
•Elder Abuse Programme
•Support to Voluntary Organisations

The Health Service Executive has piloted Home Care Grant Schemes as an alternative to long-term residential care to assist older people living at home in the community. Older people who are being discharged from the acute hospital system and those living in the community are being targeted under these schemes.

In the Eastern region people have been discharged from acute hospitals under the Slán Abhaile and Home First pilot projects. These projects have recently been evaluated and the reports of these evaluations will be available shortly.

The Department has been working with the HSE to develop a national home care grant scheme. A draft of the scheme is currently being finalised by the HSE. Funding of €2million has been allocated to the HSE in 2005 to introduce the scheme.

When a vulnerable older person has an issue with the service and the contract of care provided to them, it should be safe to expect that there are clear structures in place for them to complain. However, it should also be clear that any complaint would not prejudice the complainant. I note that notices of complaint should be made in writing to General Manager of the local Community Care Area of the Health Service Executive.

In recent years there have been great strides in developing supports for older people that feel defenceless. The HSE advised that the Senior Help Line (1850 440 444) was established with the support of the health boards in 1998 and since 1999 has received in excess of 10,000 calls from lonely older people nationwide. The service is confidential and non–directive and is available throughout the state for the price of a local call.

The HSE indicated that there are now circa 300 volunteers working from nine centres across the country – all older people who have gone through a rigorous training provided in conjunction with the health authorities.

Since 2004 the Department allocated funding totalling €72,800 for a promotion campaign which was aimed at raising awareness of the telephone number of the Senior Help Line. The HSE advised that the telephone number of the Senior Help Line was circulated to all doctors’ surgeries in the state. Summerhill Active Retirement Association received National Lottery funding totalling €15,000 in 2003 to produce a booklet and promote the Senior Help Line.

In December 2003 the Health Executive supported an independent evaluation of the Senior Help Line. This was carried out by Dr. Eamon O’Shea of NUI, Galway and launched by President Mary McAleese, who is Patron of the Senior Help Line, in 2004.

The Health Service Executive has decided to support the implementation of the recommendations of the evaluation and this implementation is now well advanced.

The Senior Help Line has been responding to issues of elder abuse since its foundation. Volunteers have received specialised training, funded by former health boards, provided by health service professionals specialising in the area of elder abuse, to enable them to deal with calls of this nature.

5% of calls in 2004 related to elder abuse. These callers establish a relationship of trust over a period of time with the older volunteers who take their calls and are often unable to seek external or professional intervention until they feel secure in discussing their situation.

The Senior Help Line has expanded in recent years and three new centres are preparing to come on line later this year. In addition, the Department of Health, through the Health Service Executive, has agreed to support further expansion of the Senior Help Line hours. Later this summer the service will also operate in the afternoons, expanding from a morning and evening service.

Each Senior Help Line centre provides support materials for volunteers with key contact details of health services appropriate to dealing with elder abuse situations where the caller wishes for such an intervention.

In addition to the Senior Help Line, this Government is committed to dealing with the problem of elder abuse. This Government is fully committed to developing the services needed to tackle this problem and in 2003 established the Elder Abuse National Implementation Group to oversee the implementation of the recommendations of the ‘Protecting our Future – Report of the Working Group on Elder Abuse’ which was commissioned by the Government.

Funding of €0.8 million was provided in 2003, €0.75 million in 2004 and a further €0.9 million was allocated in 2005 to continue with the implementation of the recommendations of the Report.

Elder Abuse is a complex issue and difficult to define precisely. It may involve financial abuse, physical abuse, sexual abuse or it may arise due to inadequacy of care. It is defined in the Report as: “A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights.” This Report, in starting with a definition of elder abuse will, hopefully, give older people who feel they are the subject of abuse in any shape or form, the confidence to report their anxieties, as appropriate, to a social worker, a public health nurse, a member of the Garda Siochána or indeed, any professional or care worker.

It is important that the issue of elder abuse be placed in the wider context of health and social care services for older people. As recommended in the Report multidisciplinary Steering Committees are being established at HSE Area level to provide a common response to elder abuse throughout the State.

The primary role of the Steering Committees is to plan, co-ordinate, support, monitor and evaluate an approach suitable to that particular HSE Area. The Report recommends that a clear policy on elder abuse be formulated and implemented at all levels of governance within the health, social and protection services in Ireland.

Steering Committees are in the process of developing clear policies and guidelines for the protection of vulnerable adults following wide consultations with staff. The Committees are progressing their work through subgroups on Legal Aspects, Policy and Procedures and Training.

The HSE continues to provide and develop multidisciplinary training for internal and external staff as recommended in the Report. The issue of Elder Abuse is being incorporated into professional training courses including gerontology courses. A number of research projects are ongoing including the examination and review of medication in older persons in continuing care settings.

In general, where problems occur with nursing homes, the inspection team who inspect the private nursing home will discuss their findings in detail with the owner/operators and this will generally ensure that the matters raised will be addressed. The HSE may remove a nursing home from its register or refuse to register a nursing home if it is of the opinion that, inter alia—
•the premises to which the application or, as the case may be, the registration relates do not comply with the regulations, or
•the continuance of services in the home will not be or is not in compliance with the regulations.

Funding of Long-Term Care
•The Mercer Report on the Future Financing of Long-Term Care in Ireland, which was commissioned by the Department of Social and Family Affairs, examined issues surrounding the financing of long-term care.
•A Working Group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established following on from the publication of the Report
•The objective of this Group is to identify the policy options for a financially sustainable system of long-term care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the Nursing Home Subvention Scheme by Professor Eamon O’Shea.
•This Group has been requested to report to both the Minister for Social and Family Affairs and the Tánaiste by mid year 2005.
•Following this process it is the intention that there will be discussions with relevant interest groups.

In the interim, work has been carried out in a number of Health Service Executive Areas, on developing standards for residential care for older people. At the same time the Irish Health Services Accreditation Board has commenced work on examining the development of accreditation standards for residential care for older people, both public and private. In this regard it is developing a pilot programme which includes both public long-stay units and private nursing homes.

It will be clear to the House from what I have just outlined that this Governments commitment to older people can not be denied. We acknowledge that we must continue to develop legislation in this area to meet the growing demand on services and that we cannot be complacent about this. However, what cannot be denied is that this Government and its predecessor can be proud of their record to date but that there is no room for complacency and that we must continue with our efforts.