23 March 2007
Dr. Henry: I welcome the Minister of State to the House and I also welcome the Bill. We were all dismayed by the report written by Professor Des O'Neill on the conditions in certain private nursing home. It became clear that we needed far more robust standards for the inspection of institutions which provide cared for people, including children, who are elderly, ill or vulnerable. This is a welcome and rapid response to the problems that were disclosed.
The Bill is wide-ranging. The provision for the scope of premises to be reviewed and certified by the inspector and his or her staff is enormous. It will take a great deal of work, even with inspections only every three years, to ensure they are all properly covered. The bill for such inspections will be an expensive one for the Minister for Finance.
I did not agree with Senator Glynn when he said it is our role only to introduce legislation and following that we have no responsibility. I was much more taken by what Senator Mansergh said on the Order of Business this morning when we discussed the issue of the State's responsibility to children in our national schools and the fact that the State, the Government and the Department have no responsibility for children who might be abused in our national schools. Senator Mansergh pointed out that legal and moral responsibility are different. I would have thought we all have a huge responsibility to ensure that this Bill is implemented and the recommendations in it are enforced.
It is easy to introduce legislation and we are terrific at writing reports but subsequently there is frequently very little action. I would like to be assured that plenty of money will be available to the inspector and to his or her staff to ensure that what we wish to achieve with the enactment of this legislation will be implemented. That is extremely important. Most people in these institutions are vulnerable. Some have relations who visit them frequently. However, Senator Glynn has often pointed out that some patients in psychiatric institutions, a service in which he had a career before he became a Member of the Seanad, have visitors very infrequently. Effectively, many of them are on their own and rely on the staff and those who should implement regulations to make sure that they are safe, comfortable, not bullied and so forth. We have a continuing interest in this legislation.
Mr. Glynn: Operational details are a matter for employees and not for the Minister of the day or Members of this House. People who are paid to do a job in an institution or a hospital should do it and not depend on the Minister.
Dr. Henry: I thank the Senator for that information but the Minister is at the top of the tree. If the authority is not doing its job, it is the Minister who is supposed to keep an eye on the authority.
The health care providers in private nursing homes will be covered by this legislation. The explanatory memorandum states:
The Authority will operate accreditation programmes and other schemes aimed at ensuring safety and quality in the provision of services. It will also be open to private health care providers to apply to the Authority for accreditation.
I am not sure who are these private health care providers. The Minister of State, when replying, might indicate who they are. The more people who are accredited under this scheme the better.
The authority will be required to bring forward a business plan. Business plans are great but the preparation of them by an institution can be terribly time-consuming. I hope this requirement does not take up too much of the authority's time. Business plans can vary, on occasion, by the hour. The legislation allows for the plan, when brought forward, to vary but I would not like to think it is one of the most important tasks the authority will undertake.
Will a logo or some other symbol be introduced that private nursing homes or residential care facilities could display? That would encourage people to obtain accreditation and meet required standards. Owners of premises, such as restaurants or shops, usually have a sense of pride and can point to a logo which shows they meet certain standards. Will certificates have to be publicly displayed in a residential unit? I did not note a reference to such a provision in the Bill.
I am glad the section on protected disclosures has been brought forward because whistleblowers want to be anonymous. We would not have had the Neary inquiry if two midwives had not gone anonymously to the then North Eastern Health Board to voice their complaints. To the great relief of myself and everybody else, the Northern Eastern Health Board management acted rapidly. What followed from that showed dangerous practice was taking place. Whistleblowing legislation was badly needed and it appears that the provision in that respect is well covered.
The Minister of State mentioned the Commission on Patient Safety and Quality Assurance which it is hoped will report by the end of 2008. If it makes any recommendations that the Minister considers would be useful to this legislation, I hope this legislation would be amended. Will the Minister encourage the amendment of this legislation so that the advice of the commission can be taken on board? There is not much point in setting up a commission on this issue if we do not act on its advice if it appears sensible.
I was pleased to see provisions in the legislation for the functions of the authority but I would prefer if they had been explained more fully. I refer to subsection 8(1)(h) which states, " to evaluate the clinical and cost effectiveness of health technologies including drugs and provide advice arising out of the evaluation to the Minister and the Executive;". I have stated both in the House and at the Joint Committee on Health and Children on many occasions that the only people undertaking assessment of health technologies are those in the drugs industry. They are most unlikely to declare that a hot bath would be better than taking some anti-arthritic drug or painkiller. It is essential that the Government ensures other technologies are considered and I would welcome this. I question whether there will be co-operation with the Health Research Board on this matter as it is a mighty undertaking for the authority. The setting up of such trials would be a significant undertaking. Does the legislation provide for the authority to do this on its own or with the help of the Health Research Board?
I remind the Minister of State that the drug companies carry out all the research in these areas. Even at international level it is rare for trials to be carried out on other treatments in concurrence with drug therapy trials. Independent hospitals will sometimes carry out such trials. For example, in the case of slipped discs, one third of patients will be given operative treatment, another third will be given drug treatment and the final third will not be given any treatment. In many of these trials, all patients turned out the same after a couple of years. This is not to say some patients did not have more pain than others. These trials are well worthwhile but they are not apparent in this legislation.
Subsection 8(1)(i) states, "to evaluate available information respecting the services and the health and welfare of the population;". This is a public health issue of significance. Will there be any co-operation with public health doctors or will the authority have a solo function? We need to know how these two subsections will operate. Will the authority do the work itself or farm it out to other institutions?
I welcome the Bill which will have a speedy passage through the Houses of the Oireachtas. I hope it is enacted in the near future.
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