The Government must honour its unequivocal commitment to an independent nursing home inspectorate, writes Tadhg Daly
In the Dáil on the day after the transmission of the Leas Cross nursing home programme by RTÉ last year, the Taoiseach was unequivocal about the need for independent inspection of all nursing homes, both public and private.
"In answer to questions asked outside the House, the inspectorate will be independent of the HSE. There should be independent inspections. The inspectorate will be independent of the HSE. Otherwise, the HSE would be referring patients and also examining facilities. The inspectorate must, therefore, be independent."
For a man sometimes given to vague, equivocal statements, Bertie Ahern could not have been clearer when he addressed the Dáil on May 31st last year as the controversy surrounding the images conveyed on that programme erupted.
"The Government is determined that a new and stronger regulatory system will be put in place so vulnerable people, particularly the elderly, are protected," he added.
A year on, the Bill to establish a new health information and quality authority has yet to be finalised.
Most alarmingly of all, the draft currently being developed by the Department of Health and open for submissions by interested parties, explicitly envisages that the inspection of private nursing homes will continue to be undertaken by the HSE.
The draft Bill envisages the creation of an office of chief inspector and states that "the chief inspector may make an arrangement with the Health Service Executive to carry out inspections in respect of certain services which the HSE currently inspects.
"They are pre-schools, private nursing homes and non-HSE homes for children in need of care and protection."
The draft says this is proposed "to allow the inspectorate to make practical arrangements so as to ensure the continuity of inspection regime for these services".
This proposal is absolutely unacceptable to the INHO and I believe the Irish people will not forgive the Government if they renege on the policy commitment of the Taoiseach given a year ago; a commitment that is pivotal to guaranteeing standards and public confidence where nursing homes and the care of the elderly are concerned.
Just as important though as an independent inspectorate process for all nursing homes (public and private alike) is the need for regulations that define in elaborate detail what standards of care should apply.
It is important to remember that at present we do have a standards regime and an inspection process, based on the 1990 Nursing Homes Act. The former is open to varied interpretation and the inspection process is too subjective.
An independent inspectorate cannot function effectively unless it has clearly defined and rigorous standards by which to measure its work; residents, their relatives and nursing home operators are also entitled to that clarity.
For instance, the current regulations simply specify that a nurse, along with a sufficient number of competent staff, must be in place, but there are no minimum staffing levels specified and there is also a need for an appropriate skills mix.
The new nursing homes inspectorate, to be established under the new health information and quality authority must be independent, must be adequately resourced with appropriately trained staff, must have clearly defined powers, and must be supplemented by a transparent and effective appeal mechanism to ensure fairness to all stakeholders
As the national representative body for the nursing homes sector, the INHO has, as it were, "put our money where our mouth is" by commissioning our own specialist reports on proper care standards and their cost. The draft standards we have drawn up would ensure minimum staff to resident ratios, including qualified nurses and care assistants. The standard of care depends largely on the number of staff and how well they are trained.
We also recommend mandatory training for care staff in both public and private facilities, covering health and safety, hygiene and manual handling, nutrition and feeding and palliative care.
We are also studying how nursing homes should be monitored from the perspective of resident wellbeing, with periodic review of residents by a geriatrician. This might also involve establishing consumer panels.
Last week, in association with Excellence Ireland Quality Association and the Irish Society for Quality and Safety in Healthcare, we jointly launched a new quality of care standard for nursing homes.
This was developed by the quality association after extensive research to develop this comprehensive standard which not only meets the current legislative and regulatory requirements in Ireland, but takes account of the global best practice standards available, particularly in Britain, USA, Canada and Australia.
It is vital that the Government take our recommendations on board to restore public confidence generally in the nursing homes sector, in particular for the 28,000 residents of private and public nursing homes, and their families.
Tadhg Daly is chief executive of the Irish Nursing Homes Organisation.