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Dáil
‹ Leaders' Questions

Public nursing homes and HIQA compliance

Summary

Micheál Martin sought clarity on funding, plans and possible closures affecting 21 publicly run nursing homes failing HIQA standards. The Taoiseach denied privatisation by stealth, defended public provision, acknowledged he lacked the detailed list immediately, and promised information on applications, planning permission and funding.

I am seeking some clarity and transparency regarding the future of publicly-run nursing homes. There was a very strong article in last Sunday's Sunday Business Post on what is an impending crisis in terms of publicly-run nursing homes not meeting the standards set down by the Health Information and Quality Authority, HIQA. Some 21 of the biggest publicly-run nursing homes are now at risk of closure due to lack of investment by the State in enabling those institutions to become compliant with HIQA standards. The alarming aspect of this is that no funding has been provided in the 2015 Estimates to bring those 21 homes up to standard. They span 14 counties, six in County Cork alone. We are talking about institutions such as Peamount, Leopardstown Park, Gorey district hospital, Tralee, Monaghan, Nenagh and many others, and of course St. Finbarr's in Cork city, Castletownbere, Bandon, St. Joseph's in Bantry, and St. Joseph's in Millstreet. The bottom line is that unless the standards are met by July, or unless there is some indication of a real commitment to meet those standards, the options are closure of the institutions, a significant reduction in beds, or closure of high-acute or high-dependency units.

The director of the HSE has warned that there is not enough funding there to sort this out. I want to know whether there is a creeping policy of privatisation by stealth. In other words, is it the Taoiseach's view that these institutions will wither on the vine and will close naturally through lack of investment on his part, and that HIQA will have to intervene? HIQA has been very clear in saying that if a centre is not in compliance by July 2015, and if no realistic time-bound, costed, funded plan has been agreed with the authority, then appropriate conditions will be attached to any renewal of registration. We need a bit of honesty from the Government now about what is going to happen.

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That would be a first.

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Enda Kenny The Taoiseach Fine Gael

I do not know what the Deputy is implying by that last remark.

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The Taoiseach should go to Balbriggan.

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Enda Kenny The Taoiseach Fine Gael

It is only right and proper that there should be quality nursing home services available for people who have to avail of them, underpinned by a proper system of registration and inspection. Deputy Martin is well aware of the age and structure of many of the older public homes around the country, which have evolved from county homes into other structures such as we have today.

There is no privatisation by stealth going on here. The nurses and personnel who worked in the public homes for so many years gave wonderful service in systems that are inadequate today but served a purpose over many years. HIQA has clearly said that the discussions going on between the HSE and itself arise from public units around the country that are currently registered but due for de-registration in 2015 or 2016. HIQA has indicated that a number of these facilities do not fully meet the standards one would expect in a modern nursing home. That is not surprising given that the age of some of them is in excess of 100 years. There are 119 public nursing homes, as Deputy Martin is well aware.

Over the last years, the capital programme of the HSE has, within the resources available to it, brought a number of the public long-stay units to full infrastructural standards as required by HIQA, and it will continue to invest in long-stay units over the time ahead. Last year, €36 million was allocated in the capital plan for the continued upgrade of public residential facilities and €122.34 million has been allocated for the period ahead. I also understand from the Department of Health and the HSE that there is adequate flexibility for solutions to be found, both within the terms of the existing legislative proposals and through discussions currently going on between the HSE and HIQA, and between HIQA and the Minister of State, Deputy Lynch. The HSE has been working with HIQA over the last months to meet the de-registration requirements of the units involved, and the Department of Health is in regular contact with the HSE on this issue.

It is true to say that the fabric and structure of many of the public nursing homes is very old in the sense that some of them are 100 years old. Efforts have been made over the last years to bring some of them up to the standards HIQA requires. It is true to say they are not all up to standard now. They have been identified by HIQA, discussions are going on between HIQA, the HSE and the Minister of State, and €122 million has been allocated from this year to bring them up to full infrastructural standards. The flexibility within the existing system will hopefully allow for a service to be provided and continue to be provided until the facilities can be brought up to full HIQA standards in the time ahead and the law can allow for that to happen.

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That is not a straightforward, honest answer. We just want facts.

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Enda Kenny The Taoiseach Fine Gael

Is it dishonest?

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People would like to know.

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Enda Kenny The Taoiseach Fine Gael

Is it dishonest?

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It is not telling the truth to the public concerned. These are very important centres in the communities. I know that questions were asked last week by the Sunday Business Post and others. I have named 21 long-stay facilities. Can the Taoiseach answer a simple question? Have plans been submitted in respect of each one of those 21 hospitals, including Castletownbere, Bandon, Bantry, Peamount, Leopardstown? Has funding been matched to the plans that have been submitted? It is simple, and no-one could give the answer at the weekend. It is all fudged and "discussions going on" and this, that and the other. HIQA had to dismiss any suggestion that there was an amnesty, which the Minister of State had said at the time. The Minister of State herself, to be fair, dealt with this issue in a written reply 12 months ago and said the money was not going to be provided - "Bearing in mind their age and structure, public nursing homes face real challenges and require investment in excess of the funding that will be available in the short to medium term." That was January 2014. Move to November 2014, and we have the Minister of State saying "my Department and the HSE are working to establish the options that may be available in this regard and how we can ensure that older people continue to be looked after." That is the kind of meaningless stuff one gets when no-one has an answer to the problem. We are getting more of it today, with respect to the Taoiseach.

I think the people in those communities, the staff and the communities that depend on the long-stay beds would like to know a very basic answer. Is it policy to upgrade these units? Is the money going to be provided? It has not actually been provided in this year's Estimates. Some €7.3 million has been provided for the upgrade of the nursing homes, while €300 million was asked for by the Director General of the HSE, Mr. Tony O'Brien. He is saying that is what it will take. There has been no publication of a three- or four-year plan, and it has been known for five years that July 2015 was to be the date. There is no public plan that we are going to do X, Y and Z over the next three years in terms of the long-stay beds in these institutions. I think it is a legitimate question - what is really going on behind the scenes?

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Give Leo a ring.

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Enda Kenny The Taoiseach Fine Gael

The Deputy's sense of righteousness is extraordinary. He wanted to know answers to some questions. I cannot answer the question for him as to whether every one of the 21 facilities he has mentioned have submitted plans for planning permission, whether planning permission has been approved for them, or whether funding has been provided in the budget for each of these 21. I cannot answer that question now but I will find the answer for the Deputy.

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The Taoiseach should have that answer now. This has been public knowledge for a long time. That is the problem. He should have it now. There is too much fudging.

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Enda Kenny The Taoiseach Fine Gael

The Minister for Health and the Minister of State have all the details about these things.

I said to Deputy Martin that €36 million was allocated in the 2014 programme.

I will give Deputy Martin the extent of the works carried out, completed and brought up to standard for that €36 million in order that we will have it not, as Deputy Martin has suggested, in a dishonest fashion but straight upfront. I will also give Deputy Martin the extent of applications that have been lodged and, in respect of the 21 cases to which he referred, whether planning permission has been granted and whether they are considered to be up to the standard required by HIQA as well as what moneys will be spent on them in 2015. I will give Deputy Martin this in detail so that he will not be able to come to the House and say that anything is being fudged. Everyone understands that of the 119 public nursing homes we have-----

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We have been asking for 12 months.

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Enda Kenny The Taoiseach Fine Gael

Some of these are 100 years old.

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Enda Kenny The Taoiseach Fine Gael

If so, Deputy Martin does not seem to remember it. The fact is that a number of these are not up to modern-day standard.

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Tell us which ones.

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Enda Kenny The Taoiseach Fine Gael

The Government publicly supports and will continue to support a public nursing home service provided in public homes for people who avail of this service.

They has never been enough money, nor is there enough now. What we must do is decide on the flexibility within the law, which homes can continue to give service for the time ahead----

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Will the Taoiseach tell us which ones will close?

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Enda Kenny The Taoiseach Fine Gael

-----and how best we can bring the other facilities up to the standard of modern nursing homes such that the people who use them can be comfortable and secure.

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Will the Taoiseach tell us which ones the Government is going to close?

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Enda Kenny The Taoiseach Fine Gael

The standards that applied years ago when Deputy Martin was Minister do not apply any longer.

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We have been looking for the list for two years.

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