Wednesday, 1 February 2006
Dáil Eireann Debate
—the failure of the Government to fulfil promises made in this House by the Taoiseach and the Tánaiste and Minister for Health and Children to introduce legislation to provide for an independent statutorily-based inspection regime for all nursing homes;
—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 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 that all completed inspections of nursing homes should be made available to members of the public on request subject to freedom of information and data protection legislation;
—commends its policy of supporting older people in their homes and communities in keeping with their stated wishes, and providing support to those who need residential care, and in that context acknowledges the significant investment made by the Government for the care of older people by the provision of €110 million additional revenue funding in the budget announcement for 2006 —€150 million full year cost.”
Mr. Nolan: This debate is timely in so far as every Member of the House would support the allocation of more resources for the care of the elderly. It is important to acknowledge the additional €110 million of revenue funding provided in the most recent budget. We must also note that people now live longer, obtain hospital treatment faster which ensures they have a better quality of life, see more specialists and work in healthier workplaces. In addition, people with disabilities are finally receiving priority and supports. For these reasons, the number of elderly people is greater than ever.
It is Government policy to ensure older people can remain at home in dignity and independence if this is their wish, while providing high quality residential care for those who can no longer remain at home in dignity and independence. It should be the policy of every Government to ensure our senior citizens can remain in the environs to which they have become accustomed, which is what they seek.
One of the down sides of a successful economy, in our case the Celtic tiger, is that with an increasing number of people in employment, families have less time to look after elderly parents or aunts and uncles. It disappoints me to receive telephone calls from members of families to tell me they are being put under pressure by Kilkenny General Hospital to take an elderly relative home on the basis that the hospital has done everything in its power for the person and there is no medical reason for him or her to continue to use a high support bed when more urgent cases are waiting to be admitted to the hospital. In such circumstances, family members will often argue that as both spouses work, they do not have the wherewithal to look after their elderly relative.
It is important that the Government continues to make provision to support elderly people, including funding for the home help service which they need to continue to live at home. The home help service, the cornerstone of community based care for older people, is delivered as part of the community support service. The investment the Government makes in the service is money well spent. A cost benefit analysis would demonstrate that the service provides much greater value for money than the large investments required in our regional, general and local hospitals.
It is also important to continue funding day care hospitals, which elderly people, including many who live alone in rural settings, avail of to meet other people in similar positions. Whether they visit such centres once or twice a week or on a daily basis, they enhance their quality of life and deserve support. I commend the Government’s policy on the care of the elderly and wish more resources could be allocated to this sector.
Mr. O’Flynn: Media reports in recent months have highlighted the dreadful conditions some older people are forced to endure. This shameful and disgraceful mistreatment of some of the most vulnerable people in society is appalling. It is incumbent on all of us in many capacities — as sons, daughters, relatives, neighbours and taxpayers — to value and care for older people. Nevertheless, the vast majority of care homes and carers are doing a remarkable job.
A report produced and published this week by the National Economic and Social Forum confirmed what most of us already knew, namely, that older people want to continue to live in their homes and communities, rather than moving to nursing homes and hospitals. They want to live as independently as possible and it has been Government policy to support them in doing so since the publication of the document, The Years Ahead — A Policy for the Elderly. Unfortunately, resources have not always been available to make this commitment a reality.
The Government is all too aware that investment in services for older people has ground to make up. In recognition of this fact, I commend my colleague, the Minister of State at the Department of Health and Children, Deputy Seán Power, for ensuring that €150 million was allocated for new services for older people in this year’s budget. This money will cover a wide range of services, including home care packages, support packages, home helps, meals on wheels, day and respite care, palliative care and sheltered housing.
The home help service is the cornerstone of community based care for older people. A sum of €30 million has been allocated to home helps in 2006. This will provide for an additional 1.7 million home help hours. The home help service provides invaluable assistance to elderly people and a guarantee of independence and dignity. This is particularly important given the changing face of modern Ireland. We all lead busier lives, commuting long distances and often living far from where we grew up. Many older people in my constituency live alone and no longer have a relative or neighbour living nearby to look in and check how they are. A daily visit is a lifeline for such people and an invaluable means of ensuring that any signs of neglect or abuse are detected in the early stages.
The NESF report found that low level supports, if provided at the right time, can have better outcomes for older people compared to services provided at times of crisis. Older people are not only vulnerable to abuse and neglect in their own homes. The Leas Cross case highlighted that while many great nursing homes across the country provide excellent services to older people and their families, others have no place in providing care for older people.
At present random inspections of nursing homes are carried out by the Health Service Executive but the findings are not published. The practice of random inspections should be continued and improved. Abuse of the elderly can be difficult to detect, especially if the individuals in question are frail or suffering from dementia. Furthermore, vulnerable old people may be too scared and intimidated to speak out about substandard conditions. It is vital that inspectors speak to patients and their families to learn about any concerns they may have.
Unfortunately, some older people have no relatives or are left to their fate once they enter a nursing home. It is vital that this group has a voice. They should be assigned a representative who can act as their voice and make their concerns, fears and worries known to the relevant authorities. Patients must not only be interviewed but also medically examined to ensure they are being properly cared for. The Government must send out a loud and clear message that it will not tolerate substandard care of elderly people or stand back and allow abuse of the elderly to take place.
Perhaps there is a case for establishing an older person’s ombudsman, an idea I float tonight in the hope that the Minister will consider it. This body or individual would work in a similar way to the successful Ombudsman for Children. In effect, it would mean that older people would have an ambassador, that is, a person or office established to safeguard their rights. This independent body would have powers to investigate complaints by older people or their representatives against public bodies. I hope the Minister will consider my proposal.
I commend the Minister of State at the Department of Health and Children, Deputy Seán Power, for expediting the proposed legislation which is being drafted. It will be fine legislation which Members will have an opportunity to debate. While progress has been made in the care of the elderly in terms of funding home help services, increases in the old age pension and fuel allowances, we must also ensure that this vulnerable section of our population is cared for, valued and safe. Anyone who has been in hospital in the past year or two will understand the vulnerability one feels as a hospital patient and appreciate the amount of care and attention one receives from hospital and care staff. Having been a recipient of the care and attention of staff while in hospital last year, I commend all carers in the health service. It is only when one receives it that one realises the importance of the service they provide.
Mr. Moloney: I congratulate the Minister of State with responsibility for the elderly, Deputy Seán Power, on his role in the Department, particularly for the increased funding for the elderly. While this debate is not entirely focussed on funding, it is important to recognise the €110 million extra for the elderly, and €302 million in total between 1997 and 2005. An increase of this magnitude confirms the Government’s approach to extra funding, which is in place, and we will reap the benefits. Given the increase in the elderly population it is right that the funding should increase. According to the 2002 census 11.3% of the population was over 65 years of age and the projected figure by 2031 is 21%. That must focus our attention on the need to provide adequate facilities and resources for the elderly.
While I welcome the motion and recognise that we need supervision for our elderly, we must also provide services for the elderly. I welcome the increase in home help services and the home care package, which is specifically geared towards the needs of the elderly. I welcome the active day care centres where facilities are available for the elderly during the day as distinct from overnight facilities. I welcome that so many levels of activity are available, and the increase in respite.
Far more can be done. It is not enough to demand more funding from the Department or that the Minister be more proactive in specific areas. Much can be done through community based initiatives. I commend to local authorities and local public representatives the securing of funding under the voluntary housing schemes for the elderly. If this was happening in every town and village we would not have such a high level of dependency on nursing homes or hospitals for the elderly. The levels of funding amaze me and I am pleased that in my home town, Mountmellick, such a scheme is available and will open next month. Between 95% and 98% of funding is available for such projects, and retired religious staff are often available to monitor the needs of the elderly. Rather than demand extra places in houses of care or hospitals we should be more proactive in the community and keep the elderly active, involved and engaged with the community. Funding available for centres within those housing compounds should target the needs of the elderly and keep them out of confinement for as long as possible. We should progress these matters and rely on the extra funding being made available by the Minister.
Many of us had firsthand evidence of problems in nursing homes by way of inspection and in some cases homes have been closed. Stories of what led to such closures would make people concerned. We must press as fast as we can to ensure inspections occur on a regular basis and without forewarning. If we secure extra funding, make it available and prepare extra facilities it is equally important that we are constantly vigilant to ensure that while our elderly are in care they are being properly cared for. The only way we can do that is by surprise inspections and a code of practice for nursing homes.
I recognise the Minister of State’s involvement in the care of the elderly. I am glad there is a specific brief in that regard, and the test must be the recognition of extra funding for the elderly on a continuous basis.
Mr. Finneran: I compliment the Minister of State, Deputy Seán Power, on the work he does with particular emphasis on providing support and help to the elderly. We must be conscious that age and an aging population will be a reality into the future. It is the case across Europe and will be on our doorsteps in the near future. We must make provision for that and deal with the current position. I, and many others, have been supportive and have spoken many times on the issue of people being cared for at home. Having worked in the health service for nearly 20 years I saw firsthand some of the unnecessary hospitalisation of people, sometimes for suspect reasons or because the nation or the Government had not thought out alternatives to institutional care for our elderly, whether in a long-stay hospital, nursing home or welfare home. While these provide excellent care in most cases it is not in keeping with the wishes of our elderly, which is to be cared for in their own homes.
In past finance debates I have spoken about the opportunity in other countries for people to take out insurance cover during their working lives to provide a home help, care or nursing system in their twilight years. The insurance companies have not introduced such a scheme, although they are readily available in many countries such as the US, Australia and some European countries. This should be promoted and I call on the VHI, BUPA and others to examine this area. This would be similar to the home help system provided by the State but through an insurance policy.
I compliment the Government in particular on the increased funds for the care of the elderly. A number of areas must be emphasised, which sometimes are cheap options which are overlooked. The opportunity of day care is not developed or encouraged to the level I would expect. In different counties people have come together, added a number of rooms to a health centre and bus in up to 100 people on a five-day week basis. Staff work through a social economy or FÁS system at little cost to the State. It gives people the opportunity to use the facilities, get meals and have social interaction, which is important.
To be parochial, I draw the Minister’s attention to the need for investment in the major elderly hospital in County Roscommon, namely the Sacred Heart Hospital in Roscommon town. Some of the accommodation has been there since the time of the Famine. I would like to see an investment there. The Minister for Health and Children visited the hospital, but there is a need for a major investment in the Alzheimer’s unit and the other three units.
We should encourage communities to develop social housing in their areas. This is an ideal opportunity for people to congregate in a village setting in units where they have a communal facility. We do not have enough of those nationally, yet there is adequate money in the Department for them. This is not promoted enough in some communities. I compliment the Minister of State on the good work he is doing.
Ms Sexton: I recognise that many pertinent points have been made so I will focus on just a few regarding the care of the elderly. However, I feel it would be remiss of me not to make reference to a contribution made here last night by a member of the Opposition, which I believe was an inappropriate and derogatory reference to the child care needs of our fellow European citizens, especially Latvians and Poles. That the remarks were made at all is reprehensible, but that they were uttered by a well educated member of the so-called caring profession makes it all the more disappointing and unacceptable. I urge that more considered and tempered language be used in the future. It is not necessary to denigrate one section of the community to make a point about another sector.
I was disappointed to hear members of the Opposition state their full and certain belief that no changes were made regarding the issue of nursing home care. During a very successful conference called Aging Ireland — Shaping the Future, which was held by the Progressive Democrats in 2004, a consultation process was held where advice from independent contributors and key stakeholders representing the elderly were considered. The promoter of the seminar was none other than the Tánaiste. To suggest that the Government, the Minister of State, Deputy Seán Power, or the Minister for Health and Children does not have a commitment to the elderly is absurd. No one individual or party has a monopoly on compassion.
The charges levelled in the motion defy the facts, such as the €110 million announced as additional funding in the budget for care of the elderly, which is the equivalent of €150 million in a full year. Since 1997, additional spending in excess of €300 million has been provided for health care services. This record investment will deliver home care support packages, home help, stay and respite centres, specialist palliative care, increased meals on wheels services and more sheltered housing. We know that we must put additional funding into these areas. This investment will also allow for many more excellent initiatives in primary and community care for the elderly, all of which illustrates the inaccuracy of the views expressed in the Private Members’ motion. The Government is committed to making meaningful progress in the care of the elderly and I wish that the motion was more proactive in its content, rather than critical.
Investment is particularly evident with regard to the abuse of the elderly in care, which is an issue underlying the Opposition motion. A total of €4.5 million has been provided and ring-fenced to implement the recommendations of the report entitled Protecting Our Future, which provides the definition of abuse of the elderly and gives the more vulnerable older person the confidence to report his or her concerns. The draft heads of the social services inspectorate legislation are at an advanced stage and are expected to be submitted to the Government, which will provide for an office of the chief inspector of social services and the welcome establishment of a registration system in respect of residential services for older people, children and people with disabilities.
The national nursing homes steering committee was established last July and was charged with standardising inspection documentation, making the inspection information as transparent as possible. All of us look forward to the day when all that information will be available on the Internet. The motion is misleading to pretend that the public cannot access information. The public can access information on request from both the HSE and nursing homes.
Caring for the elderly in the home is the way forward and I am delighted at the significant levels of increased funding for the elderly, which will be targeted at insuring that older people in this country can access their needs in the most appropriate setting of their choice. I have every confidence that the Government will continue to ensure that the funding is directed to that area.
Mr. Cassidy: I endorse everything that has been said by Deputy Sexton. I congratulate the Minister of State on the work he is doing. He is a great friend and colleague and his father before him gave great service to the State as a Member of this House for over 20 years.
The care of the elderly is an area that must be supported by everyone, regardless of party affiliation. I was a member of the Midland Health Board from 1985 to 2002 and I am very aware of the hard work and the dedication of the staff in all our institutions which care for the elderly in Westmeath, Longford, Laois and Offaly. The care being given to our senior citizens in private nursing homes is also second to none. The nursing staff should get gold medals for their commitment and for what they are doing in the interest of our elderly senior citizens. I have great respect for the professionals from the health service who are Members of this House.
I have respect for the Fine Gael Member who contributed to this debate last night. I listened very attentively to the Deputy’s remarks and we cannot beat the professionals with the experience coming in here and assisting the Government. That is good oppositional politics. I agree with Deputy Sexton on some of the views made by the Deputy, but I would welcome in the House the expertise displayed in the committees, and the public will appreciate it far more.
The allocation that has been made regarding the long-stay home subvention and additional long-stay bed capacity has to be welcomed. In particular, I welcome the threshold by which a person can now enter a nursing home. If the house is worth €250,000, the person is now entitled to a subvention. There are many people whose parents are in nursing homes who are becoming the new poor in Ireland because their parents did not qualify for a subvention. Parents went into long-term care, hoping to come home as soon as possible, but were left in a situation where they had to sell the family home and spend all the money on care before a subvention was granted. The Minister of State, Deputy Seán Power, as well as the Minister for Finance, are aware of the difficulties in our midland region and have the experience to bring this before the House. I welcome the fact that the threshold is now €500,000 for Dublin and €300,000 for the rest of the country. It has been an enormous assistance and it will leave many people in nursing homes and long-stay institutions with much peace and happiness.
I welcome the efforts being made by the Government on long-stay care, as well as the strongly held views of the Opposition and the professional advice which Members can give the Government. We are all trying to achieve the same result at the end of the day.
I thank the Fine Gael Party for bringing this motion before the House. Yesterday in the House we spoke about the new trend towards privatisation in the health service. There is a section of the health service, however, which has been privatised for quite some time, namely, the nursing homes area. It is a lucrative business. It is a business and not a vocation for this new breed of entrepreneur which might as well be selling carpets or second-hand cars for all the sensitivity shown sometimes to the elderly and most vulnerable people in our community.
That is shameful and clearly these people are being treated as a commodity. We are talking about the old, the infirm, the sick being treated as a commodity. The less regulation we have the more profit they can make. That is the bottom line. We could be cynical and say the Government is delaying while they make more money on the backs of these very vulnerable people. We are heading now towards the lowest common denominator. When I spoke in the House previously about this I gave examples of what was happening. I was told this by a nurse who had contacted me and these stories are really quite appalling. She spoke of a nursing home in Cabra where she works. Older people there would sometimes wet themselves at night. They were not properly dried and the uric acid would give rise to bed sores. Why did this happen? It was because the staff members were poorly paid and were not properly motivated. This is what is going on.
To save money sometimes they would not get the extra glass of milk they asked for. If they were given bread, it was pre-buttered. Skimping on basic necessities, they were kept downstairs in the cellar very often. As she said, they were very often doped out of their minds with Valium so that they could go to bed earlier. This is what is going on and why we need inspections. I ask the Minister of State not to delay any further on this. It is going on wholesale because people want to make money. That is at the root of the problem.
The Minister of State told me in the House on 21 June last that he would come back with information. At that stage I had said there were 33 nursing homes that had received adverse inspection reports. The Minister of State said that he would get back to me and that it was not a problem. He said: “It is not our intention to defend nursing homes which do not provide an acceptable level of care, particularly where the Department has assisted people to move into long-term care.”
Mr. Gormley: I would like the Minister of State to do so, and to put it on the record of the House. It is very important that we have openness and transparency and that we get to the truth. As this society becomes older — and this is happening throughout Europe — this will become probably the most important issue, along with pensions and care for the elderly. Our health services will cost more and more money because people are getting older and more people will have to go into nursing homes. I ask the Minister of State to move on this legislation as a matter of urgency.
Caoimhghín Ó Caoláin: I support the motion tabled by the Fine Gael Deputies and I commend their initiative. The Government’s amendment, quite simply, is not adequate. It rows back on the commitment given by both the Taoiseach and the Tánaiste last year in the wake of the Leas Cross nursing home scandal. Both the Taoiseach and Tánaiste clearly committed to an independent nursing homes inspectorate. There can be no question about that and people will recall one of the most revealing moments in the “Prime Time” documentary which exposed the disgraceful ill-treatment of elderly and vulnerable people in Leas Cross. One of the Leas Cross staff was secretly filmed after a visit to the home from the health board’s inspector. She said: “They were just concerned with the paperwork”.
The health board and later, the Health Service Executive inspectors, failed to protect these elderly people and that is the bottom line. I have no doubt that some improvements have been made in the inspectorate regime for nursing homes, but why did these elderly people have to suffer, and why did we have to wait until it was exposed in the media before action was taken? It is estimated that at least €500 million of public moneys has been ploughed into nursing homes since the tax reliefs were introduced in 1997. The owners of Leas Cross benefited from this tax break, but we have not been told by how much.
Sinn Féin believes this money should be spent, not on subsidising private facilities, but on public health and social services including nursing homes for the elderly and greatly improved care and support for them in their homes and in other community settings. Today the Dáil took the Report Stage of the National Economic and Social Development Office Bill. The National Economic and Social Forum comes into its remit and on Monday of this week it issued another very important report, which has not received the attention it deserves. I have no doubt the Minister of State has taken the time to consider it, but the report is entitled Care for Older People. Describing the barriers to the development of community services for the elderly, it refers to “perverse investment incentives”. The present official funding of services is not consistent with the policy objective of encouraging community based responses, says the report. Considerable resources are invested in nursing home care responses, some of which are unnecessary and inappropriate.
This reinforces the point about the use of tax subsidies for private nursing homes. It is little wonder that the scandal of Leas Cross and other homes has occurred. The NESF report quotes from the report of the working party on services for the elderly, from 1988. That identified lack of co-ordination of services as a key concern. That lack of co-ordination, sadly, today remains largely as it was back in 1988.
The Government amendment refers to the social services inspectorate and speaks of extending its remit and recommendations. If that is the case, then it should extend them in line with the recommendations in this area in the NESF report. The remit of the social services inspectorate, it says, should be extended on a statutory basis to include all care settings for older people — residential, community, home-based, private, State-owned or whatever, with the necessary trained staff and financial resources.
It says inspection findings should be published, with sanctions for non-compliance with standards. The principles of autonomy and person-centredness should inform the development and implementation of standards. These should be clear, adequate and developed in consultation with users. Standards of care for older people and acute hospitals, says the NESF, should also be developed. It recommends the proactive development of higher standards to move care towards quality of life measures. It says standards need to be developed across all service levels, from front line service delivery, organisation of care, planning integration and strategic development.
Will the Minister of State say whether the NESF report will be left to gather dust, just like its predecessors on equality in hospital care and on social housing? I appeal to the Minister of State that this must not be allowed to happen. Older citizens and those in need of care within nursing home provision all deserve better.
Dr. Cowley: It is hard to say all one wishes to say in two minutes but I will try. People have referred to the fact that there are so many private nursing homes. Only 5% of the population end up in nursing homes but the difficulty is that there appears to be a rush on the part of the Government to allow people to make money out of older people. While there are very fine people doing that, unscrupulous people will cut corners and care standards will suffer.
An independent inspection system is most important. It should be extended across the board. Why do exemptions exist? Currently, only institutions that are registered under the nursing homes Act will be visited. Why are there exemptions under this Act for institutions that have “handicapped people”? That should not be the case. How would the State institutions fare under the inspections that nursing homes get? I doubt that many of them would fare well given their decrepit and old, falling buildings. That must come, however, and the sooner the better. There should be no exceptions.
Approximately 95% of people will remain at home and there must be support for them. I was disappointed that when I met the Minister of State with the Irish Council for Social Housing it was not possible to increase the funding, except marginally, for a defined revenue funding scheme to keep people in their communities. The Government pays lip service to that. I welcome the improvements in that regard, in the home subvention scheme and so forth, but a defined revenue funding scheme could have taken 20% of people out of the nursing home situation.
Funding uncertainty for people in nursing homes should be rectified. Our spending on social protection for older people is just 60% of the EU average. We should spend more and it should be spent on keeping people in their homes and, when that is not possible, in sheltered housing. That should be supported by a defined revenue funding scheme. The scheme needs €2 million, not €500,000.
Mr. F. McGrath: I am grateful for the opportunity to speak on this motion and on the urgent need for an independent inspection regime for all nursing homes. This is a key issue which is of major importance for our elderly. They deserve a quality service, respect for their dignity and an opportunity to live out their final years in comfort.
I take this opportunity to thank and commend the many nursing homes in the State which carry out excellent but difficult work. I also commend the magnificent work of the staff. We have heard the bad stories but we must thank those who have given great care and have been examples of good practice. It is important to make that point when debating this issue. The vast majority of staff working in nursing homes are doing an excellent job.
However, that does not mean there should be complacency about the rights of our elderly. It is time to end all the old guff about care for the elderly in their homes and communities. It is time for action and investment. There are thousands of elderly who are living alone, who are lonely and without back-up services.
I must also raise the issue of the biggest robbery in three decades. The Supreme Court’s decision to reject the Government’s Health (Amendment) Bill confirmed the biggest theft of our time. I speak tonight on behalf of the elderly. A sum of €3 billion was stolen from more than 300,000 older people over 30 years. The implications of the Travers report were devastating and clearly showed up the State-sanctioned elder abuse that went on for three decades. It also showed the complete lack of political leadership by successive Governments.
This motion is about improving the care of the elderly in nursing homes. It is about keeping families informed and satisfied about the standards of care in nursing homes. I urge all Deputies to support this excellent motion on
caring for the elderly.
Mr. Healy: It is important to make the point, in view of some of the contributions to this debate, that everybody across the political divide is anxious to see our elderly live out their lives at home in their communities and availing of day care centres and sheltered housing. It is only in a situation where they are no longer able to avail of those services that the nursing home option is considered. The vast majority of patients in public or private nursing homes are there as a last resort.
An important point must be made about those patients and families who have, effectively, been forced into private nursing homes. These people are medical card holders who would otherwise qualify for public care. Their families are in severe financial difficulty as the subvention system is simply inadequate. It has not been upgraded since it was introduced almost ten years ago. A patient in a nursing home on an old age pension of €180 per week and a maximum health board subvention of approximately €240 per week must pay approximately €150 per week. That is the situation for each family. It is unacceptable and it must be changed. Those patients are entitled to public care and that should be provided.
Mr. Connolly: Elderly people in nursing homes are generally as vulnerable and utterly reliant on other people for their care as young babies who are totally dependent on their parents in their first months and years of life. These elderly residents of nursing homes have, by and large, contributed massively to society and warrant commensurate treatment.
A general level of care is important but these people have a right to a dignified existence, with the right to intellectual stimulation and rights of association and participation with staff and other residents. It is important to check the length of time staff spend interacting verbally with patients. Patients should be kept abreast of current affairs and not out of sight.
The remit or responsibility of a nursing home inspectorate should extend to Northern Ireland where our Health Service Executive subvents many nursing home residents. We should know how people are treated in nursing homes in Northern Ireland. Another issue is mealtimes and bedtimes, which should be subject to scrutiny by the inspector. Last meals, for example, are sometimes served at 4.30 p.m., with patients pushed off to bed afterwards. That is not sensible or right. These are quality of life issues which must be considered.
A new practice is the grading of price structures in a nursing home. In other words, a patient might go into the home under package A which entitles them to a physiotherapist and, perhaps, a walk during the day or a different type of meal. That is a dangerous precedent and it should be nipped in the bud.
In addition, the concept of unannounced visits should be an important part of the inspectorate’s duties. We saw the farce that occurred in the psychiatric services where it was known when the inspectors would arrive and everybody naturally put their best foot forward. The visits should be unannounced. I support the motion.
Mr. J. Breen: It is shameful that today, 1 February 2006, we are debating the lack of legislation to provide for an independent statutorily-based inspection regime for all nursing homes. In 2001, promises were made about the introduction of such legislation and it was only the “Prime Time” programme broadcast in May 2005 which tweaked the conscience of the Government and brought about further debate.
In June 2005, the Taoiseach told the Dáil that legislation would be before the House in the autumn to improve inspection powers and increase the number of inspections of nursing homes. Since then how many extra inspection teams have been established? How many of the recommended two annual visits to each of the 479 nursing homes in the country have taken place? What standardisation of actual inspections has been effected to ensure all nursing homes meet suitably high criteria of care? I hope I can get answers today as it is impossible to get that information elsewhere.
The Taoiseach told the House on 1 June 2005 that these changes were already being implemented under the new Health Service Executive and that new legislation would be before the Dáil in the autumn. On 29 September 2005 all members of the Opposition urged that the legislation be introduced immediately. On that date the Tánaiste was sent into the House, presumably so the Taoiseach could not be accused of telling half truths or lies. When pressed as to when we might see the proposed legislation the Tánaiste hesitated, dithered, paused and fudged. Eventually she almost said yes, that it might come before us in the autumn.
On that date the Tánaiste told the House: “A strong focus of Government actions this autumn will be on care of the elderly issues”. For a subject that is such a priority for our Taoiseach and a burning issue for both the Tánaiste and the Minister of State, Deputy Seán Power, it beggars belief that the reason legislation was not even on the A list was because the Bill had not been cleared by Government.
Who else must die before this Government acts? Is it not enough that the whole country witnessed the scandalous treatment and death of Peter McKenna and the scandals of Rostrevor House, Rathfarnham nursing home and Leas Cross? Shame and shame again on the Taoiseach, the Tánaiste and the Minister of State. They are a disgrace.
Mr. Neville: I welcome the opportunity to speak on this issue. I am pleased that the Minister with responsibility for the elderly is here. The State can be judged on how it deals with its most vulnerable people, our young people, those with disabilities and our elderly. In all these areas the Government has failed dismally to provide the quality of life our most vulnerable deserve.
Our most vulnerable elderly, those in nursing homes and those incapable of independent living have been the most neglected. This is manifested in many ways, including the neglect of the home help service and the lack of step-down beds for those leaving hospitals. There is pressure on families to accept people from hospitals who are not physically ready to go back into their community.
One of the worst areas of neglect is the control and inspection of nursing homes. The regulations on nursing homes were hailed as a panacea that would ensure the elderly in nursing homes would have a basic standard of service and quality of life. Without an independent statutory based inspection regime, these regulations are useless. They are not worthy of the paper on which they are written. It is obvious the current inspectors have failed to produce reports that are accessible and available to the public, the nursing home residents and their families, who on numerous occasions have spoken at Deputies’ clinics of their concerns about the treatment of our elderly in nursing homes. I am sure the Minister of State has experience of this, particularly on account of his responsibility in this area. He must agree there is serious concern in this regard.
The Government has no commitment to care of the elderly in the community or in the residential sector. The Minister has dragged her heels on the issue. The proposals put forward by Deputy Twomey will protect the elderly in every area of society. The Government has made repeated promises in this regard. It has regularly stated that it recognised the problem and would deal with it. Legislation was promised before the end of 2005, but nothing happened. In April 2005, the Tánaiste gave commitments in the health strategy Quality and Fairness — A Health System For You, as did her predecessor in the social partnership agreements of 2003 and 2004. In An Agreed Programme for Government of June 2002 another predecessor gave a similar commitment. On the establishment of the social service inspectorate on a statutory basis, we were promised an extension of this remit to other social services, including residential services for older people. However, nothing has been done.
There is growing pressure on people with regard to the cost of nursing home facilities. Charges have increased dramatically in recent years, but no attempt has been made by Government to address this. The current subvention levels came into effect in 2001. Nursing home charges have increased substantially in the past five years, yet the subvention does not reflect the proportional support envisaged in 2001 for the cost of nursing home care. A formula was determined in 2001 that worked out the subvention in proportion to the costs at that time. This has not been updated. The Minister of State should immediately revise the three rates of subvention payable at the three levels of dependancy, medium, high and maximum.
I was extremely disappointed that despite some indications this would be reviewed, the Minister of State informed me yesterday there are no plans to increase subvention rates at present. Will the Minister of State revisit this issue and respond to the pressures placed on nursing home residents and their families?
As life expectancy grows, it is important to give particular consideration to the mental health needs of older people and to provide a comprehensive range of services appropriate to their needs. Unfortunately, our current psychiatric service for the elderly is totally inadequate. It is no response for our elderly with psychiatric and emotional difficulties. People of advanced years are faced with stresses and challenges resulting from the loss of people closely attached to them, changes in their vocational and social roles and the depletion of their general health and physical capacities.
There are only 62 acute designated assessment and treatment beds for mental health services for older people. Some are in specially designed locations with acute general hospital units. Others are available from the mental health service for older people on request from the general psychiatric area rather than being specially designated for the elderly. There are just seven day hospitals providing a service for fewer than 100 places and only 469 continuing care beds. There are major gaps in current mental health services for older people. These include absence of mental health services for older people in many catchment areas, incomplete multidisciplinary representations in almost all existing mental health services for older people’s teams and lack of specialised assessment and treatment in most acute admissions. There is inadequate accommodation in continuing care facilities under mental health legislation. I would comment further on this if I had the opportunity. There is a lack of dedicated day hospital facilities in almost all services and a lack of services on recovery and positive coping skills in existing service positions.
The Minister of State must as a matter of urgency give priority to establishing comprehensive specialists for mental health services for older people where none currently exists. There is an urgent need for physical resources essential to service delivery. Acute beds and continuing care service headquarters and community based day facilities should be provided for the elderly with mental health difficulties. We need a full examination by the Minister of State on the needs of the elderly with psychiatric difficulties, much of which come with age, and of the difficulties experienced by people dealing with them.
Mr. McCormack: We must acknowledge that the majority of private nursing homes provide excellent care to their patients and that many families are grateful to be able to avail of the services of such homes for their relatives. However, this debate is very important. Its purpose is to ensure our elderly will be well cared for in our nursing homes. The “Prime Time Investigates” programme showed what happened in some nursing homes and demonstrated for us why the putting in place of the inspectorate is so important.
Why are there such long waiting lists for our public nursing homes, for example, the long-stay care in Merlin Park Hospital in Galway which has a two or three-year waiting list? St. Brendan’s nursing home in Loughrea also has a two or three-year waiting list. The State should be in a position to provide more public nursing homes. Many of our public nursing homes provide excellent care. I visited one in Clifden recently where the patients get top class care.
It is difficult for an older person living alone to get a place or to afford private nursing home care. A person on an old age pension without relatives could not afford the €500 or €600 a week charged. Many of these people are denied subvention through an anomaly in the means test.
In the budget the Minister for Finance used a sleight of hand when he pretended to raise the thresholds to €500,000 for a house in Dublin and €300,000 for a house in rural areas. However, he did not really raise them. If a house in a rural area is valued at over €300,000, the owner does not qualify for the subvention. If, for example, one’s house is worth €250,000, 5% of the value of the house is assessed as income. This amounts to approximately €12,500. The income limit to qualify for the full subvention is €11,000 and therefore if one’s house is valued at €250,000, one does not qualify for the subvention.
It is all very fine for the Health Service Executive or the Minister to ask why relatives do not sell the house and cater for the owner in a nursing home but many people in nursing homes really believe they will be returning to their houses the following summer. They believe they would be cutting all ties with their communities if they sold their houses. Selling one’s house, therefore, is not a viable proposition. Irrespective of who remains in a house after the owner enters a nursing home, even if nobody remains in the house, 5% of the value of the house is regarded as income. This is codology in respect of people in rural areas who enter nursing homes.
The Government amendment notes the Government is committed to introducing legislation which, inter alia, will establish the social services inspectorate function on a statutory basis. The Minister for Health and Children, the Minister of State, Deputy Sean Power, and the Taoiseach promised in the Dáil that the legislation would be introduced last autumn, but we are still waiting. In the meantime, many people in nursing homes may be suffering from treatment similar to that exposed in the “Prime Time” programme.
There were numerous promises in 2001 to introduce a nursing home inspection regime. The Government committed in the health strategy, Quality and Fairness — A Health System for You, Sustaining Progress, the social partnership agreement for 2003 to 2005 and An Agreed Programme for Government, dated June 2002, to the establishment of a social services inspectorate on a statutory basis and to the extension of its remit to other social services, including residential services for older people. This was stated by the Tánaiste in the House on 4 April 2005.
Research has shown that most people would prefer to live out their lives in their own homes and communities. However, nothing is geared to help this happen, particularly in rural areas. County councils and the Health Service Executive ran out of money last year. I could quote letters referring to there being no money for the essential repairs grant for the elderly. Sometimes people are forced into nursing homes as a result of their not being able to carry out such repairs. Letters refer to there being no money for the disabled person’s grant. I knew of some people who applied for it but who passed away before it was sanctioned. They might have been looking for a downstairs bedroom or bathroom as a result of their being unable to go upstairs, but no money was made available for the necessary work.
Home help hours have been cut back seriously. I recently dealt with the case of an 88-year-old woman in my area of Clonbur whose son was trying to keep her in the house for as long as possible. Up to last September, he was receiving eight hours of home help but the number of hours was then cut to four. He struggled as best he could and I have been struggling ever since to have the eight hours help restored. If I succeed, he will be able to keep his elderly mother, who suffers from Alzheimer’s disease, in his own home.
When I contact the Health Service Executive about this problem, officials tell me they cannot allow eight hours because of the embargo on recruitment. When I asked the Minister about this on 25 January, I was told the Department had not imposed an embargo on recruitment for home help services. She also stated €30 million has been provided for the home help service in 2006, which will provide 1.6 million extra home help hours. When I contacted the Health Service Executive, the officials said they never heard of this. Will somebody please send the Minister’s message to the executive, particularly in my area, and tell it there is no embargo on the recruitment of home help staff, who would enable people to stay in their own communities for as long as possible?
This generation is losing out greatly and it will be regretted by our grandchildren and others that we are putting our elderly relatives in nursing homes and institutional care rather than keeping them at home. The value of elderly persons in the community and their experience of life cannot be measured, nor can the value to grandchildren of having an elderly person in the home or an adjacent home.
If more resources were allocated for home help, the essential repairs grant for the elderly and the disabled person’s grant, we would have a better community entirely. There is no point in stating fancy figures, such as the €150 million allocated in the budget and the Social Welfare Bill for the care of the elderly, because the results are not seen on the ground. Is the money going into administration? Where is the €30 million the Tánaiste referred to in Question No. 352 of 25 January 2005? The Health Service Executive knows nothing about it when I ring it up. I have rung it on five or six occasions about the aforementioned case in the north Connemara area. This is only an example and one could multiply it by thousands to indicate the number of people being refused home help hours who are attempting to keep their parents or loved ones at home rather than in institutional care.
The Government and the Department have a lot to answer for in terms of their neglect of the elderly. Maybe Ministers are so busy with their own lives and Departments that they do not realise the hardship being experienced. However, I am sure they, as Deputies, realise it because they must note the problems raised in their constituency offices, just as I and other Deputies encounter the real problems old people face in both urban and rural areas. It is the wish of most families to keep elderly people in their communities rather than put them in institutional care. They should be given the necessary State support rather than be forced to deal with the red tape of the Health Service Executive.
In the case to which I referred, the Health Service Executive officials said they could identify a person willing to work evenings, thus supplying the necessary home help, but that there was an embargo on recruitment as the executive area had its full complement of whole-time staff. I was told this on 20 December, at which time it was stated circumstances may change in the new year. We are now a month into the new year but the position has not changed. Will the Tánaiste get on to somebody in the executive, such as Mo Flynn, with whose office I dealt today, to inform officials in the various executive areas that the €30 million is available and that there is no embargo on the appointment of the staff necessary to allow relatives keep their loved one’s in their homes for as long as possible?
Tánaiste and Minister for Health and Children (Ms Harney): The Government is firmly committed to developing and improving services for older people. In this year’s budget alone we have made a step change in the level of new investment in services for older people, particularly to support services in the community.
In the time available, I will address some points in the debate about our legislative programme. The legislation providing for the establishment of the social services inspectorate on a statutory basis is being incorporated into the Bill establishing the health information and quality authority, HIQA. The preparation of the heads of this Bill is at an advanced stage in my Department and I expect to be in a position to submit them to Government within the next month. I will then publish the heads to allow for a period of consultation on the proposals contained in the heads.
My intention in publishing the heads for consultation is to ensure that all interested parties have an opportunity to make their views known on the policy proposals contained in the heads at an early stage before drafting of the Bill is finalised. We will draft the Bill, taking on board those views, with the intention of publishing it as early as possible this year.
In the legislation, I envisage the social services inspectorate function would be carried out through a distinct office of the chief inspector of social services. The legislation will propose that HIQA will set the standards for health and personal social services. The office of the chief inspector will monitor residential services provided for older people with disabilities and children, provided in accordance with the Child Care Act 1991 and Part 2 of the Children Act 2001, against the standards set by HIQA.
I propose that the legislation will provide for the establishment of a registration system to apply to residential services for children, older people and people with disabilities. In preparation, I have established a working group to develop standards for residential care. Membership is drawn from my Department, the HSE, the social services inspectorate and the Irish Health Service Accreditation Board. There will, of course, be consultation on the work of the group with relevant bodies.
The legislation in regard to refunding long-stay charges was also raised. Draft heads of this Bill were approved by Government before Christmas. It is my intention to have the Bill published in the current parliamentary session. We can expect that repayments will commence shortly after the Bill is approved and signed into law. We are also working on important legislation on eligibility for health services in general.
With regard to home care grants, I have been advised by the HSE that, with €35 million new funding in 2006 in regard to home care packages and €30 million extra for home help, the home care grant will be mainstreamed in the HSE southern area. People on the existing waiting list will be prioritised. The scheme in future will form a part of the national home care package initiative. In the context of the additional funding of €20 million being made available nationally for nursing home subventions, the HSE southern area will in particular assist people who have applied for and been approved for enhanced subvention.
Some Deputies referred to a difficulty in obtaining information from the HSE. I have been advised by the HSE that its parliamentary affairs division currently replies to approximately 70% of parliamentary question referrals within the HSE’s target period of 20 working days. The HSE is committed to improving this performance. Currently, it is issuing interim replies where it is not possible to issue a final reply within 20 working days.
The Government is working at every level to achieve substantial improvement in services and standards of care for older people. Over the past year, the Government has established an interdepartmental working group, chaired by the Department of the Taoiseach, to consider many of the issues that confront the elderly in our society, particularly in regard to continuing and ongoing care. That group has recently reported and the Government is currently deliberating on its recommendations. I hope that in the context of the upcoming negotiations on social partnership, long-term care will become a main feature of agreement between Government and the social partners.
Our society must have clear priorities, in particular with regard to community and home-based supports. Evidence has shown that where families are given support, the level of care the family makes available increases rather than decreases. A recent study by Trinity College, Dublin of home care packages provided in the Dublin area suggested the average time given by the family increased to approximately 43 hours per week. This is the model the Government must support in providing new measures, initiatives and incentives for the elderly in our society to remain in their communities for as long as possible, which is their wish.
Mr. Perry: I thank the Ceann Comhairle for bringing this important motion before the House. I acknowledge the Tánaiste’s point with regard to the payment of outstanding charges. It is good to know the legislation will be introduced this session because many people are anxious as part payment has not been made and they want to know the reason for the delay. Given that €2,000 was offered by the Department to those listed on its register, it is unfortunate that some payments were not made in this regard.
Many beds in Sligo are empty as a result of subvention. Apparently, while the cost of a bed might be €800, some families in the west pay €300 to €400 in addition to the pension and subvention whereas a similar bed in Dublin would only cost €200. There is no parity and the Minister might check this because the cost of running a nursing home is the same in the west as on the east coast. It is hard to explain the discrepancy.
With regard to the MRSA bug, I am surprised that while the public health inspectorate is allowed into hospitals, it is not allowed into public wards or nursing homes to carry out unannounced checks. That may be dealt with by the new inspectorate but, in the short term, unannounced checks would be welcome.
The Government has ignored the inspection regime for too long. Without the promised inspectorate, more horror stories about conditions in nursing homes are in store. We all remember how quickly the Government was able to introduce legislation to make legal the practice of charging elderly patients in nursing homes. This is in stark contrast to its failure, despite numerous promises, to bring forward legislation for a statutory, independent inspection regime for all nursing homes, be they public, private or community based.
Mr. Perry: The farming community has a high level of inspection but when it comes to the care of the aged, it seems extraordinarily difficult to develop an inspection regime that can carry out an unannounced hygiene audit.
I have been involved with the Excellence Ireland Quality Association awards for many years. Its inspectors enter business operations and check everything, which should be the case in regard to nursing homes. There should be a standard of accreditation for nursing homes, such as a Q-mark, which would accredit that they have been subject to unannounced checks. There is no point telling those running a unit that it will be inspected next week — the inspection should be completely unannounced. I am astonished that standards have lagged with regard to the care of the aged. Inspections should have been in place years ago.
The Taoiseach, the Tánaiste and the Minister of State, Deputy Seán Power, all promised legislation. Of course, they were echoing a litany of unfulfilled commitments in a series of Government publications. While the issue of making refunds is complicated, it is extraordinary that the process has taken so long. Many people who were due payments have died in the past year and a half and the process has been marked by uncertainty for people who felt they were due payments, unclear legality in the collection of charges and the fact that next-of-kin will now benefit from the fund.
Continuing to break Government promises is a direct contradiction of the recommendations of numerous reports on the elderly which the Government commissioned, including the most recent report of NESF. The absence of such a regime means the standards applying to nursing homes are unclear and, in particular following public concerns about conditions in some nursing homes, it is essential that this system is made absolutely transparent to reassure people in their latter years.
The inspection regime is particularly vital because it should inform the HSE’s decisions on the registration of nursing homes. It is wrong that a nursing home can open without the application of strict qualification criteria. If one opened a hotel, strict rules would apply before it was awarded two, three or four stars. Similar accreditation should apply to nursing homes. They should be star-rated according to different categories and facilities, and charges should relate to the star-rating of the facility. It is extremely worrying if, as one newspaper report reveals today, there are certain cases where this is not happening. How can we have faith in the organisation which is meant to ensure our elderly people are placed in appropriate care if, in some cases, it ignores the advice of inspectors?
This is yet another reason for the inspection regime to be put on a statutory footing, to ensure the inspectorate is properly resourced and to make the inspectors’ reports fully available to the public. My fear is that, if the Government continues to drag its feet, we will hear many more of the nightmare stories about the treatment of elderly people in nursing homes. I accept there are some fine nursing homes but having an independent inspectorate which would award qualifications and accredit institutions is critically important. I am somewhat disappointed that, given the scandal relating to MRSA, public health officials who are highly qualified and capable of carrying out independent inspections of hygiene in hospitals do not do so.
Dr. Twomey: I thank everyone who contributed to this motion. The health strategy was always the basis for the Government’s blueprint for the health services. If one reviews the strategy in respect of care of the elderly, it becomes clear the Government has failed miserably. There is no doubt about this.
Earlier on, Deputy Sexton attempted to play the race card in a slightly more subtle fashion than the Minister of State with responsibility for children, Deputy Brian Lenihan. All we stated last night was that, the €1,000 to be spent on child care was expected to be spent in accordance with the budget. I was surprised that Deputy Sexton attempted to play this race card again when the mantra of her party, the Progressive Democrats, has always been transparency, accountability and value for money for the taxpayers’ money. At budget time, it was expected that this money would support child care. In stating this, we are not being racist. We are simply pointing out that if the budget states that taxpayers’ money will be spent for a particular purpose, the Government should spend the money for that purpose. The same principle applies to the €56 million whose position in the accounts book the Government was unsure of last week and the €156 million wasted on the PPARS system last year. This is why we raise these issues in the House.
Dr. Twomey: The contributions of other speakers have been quite informative. The chairman of the Oireachtas Committee on Health and Children, Deputy Moloney, stated that many nursing homes in his constituency left much to be desired. This is a very interesting point. It is extremely difficult to close down substandard nursing homes although one Deputy stated that some of these nursing homes have been closed down. Even though we criticise the lack of a legislatively based social services inspectorate for nursing homes, when these homes are inspected and problems are uncovered, it is extremely difficult to do anything about it. This has a knock-on effect on nursing homes which provide an excellent service and show genuine concern for their patients. If too many rogues are allowed to operate within this business and feel they can operate with impunity, it will affect people working in this sector who do their best for patients.
A member of the Oireachtas Committee on Finance and the Public Service stated that people could take out private insurance to pay for their nursing home care in the future. This is surprising given that the Government failed to publish a policy on care of the elderly, a measure which was promised in 2001 but which we are now told is only at the level of a Cabinet working group. This type of slow progress does not do anyone justice, particularly those who expect this Government to make decisions on the matter. There are more than enough reports for the Government to read, some going back as far as 2003.
The chairman of the Oireachtas Committee on Enterprise and Small Business, Deputy Cassidy, spoke in a more measured fashion and had some words of praise for what members of the Opposition are attempting to do this evening. This praise was unexpected but we are grateful for it. Unfortunately, we have a very adversarial form of politics here. The consensus form of politics, where we could possibly work together, is not used. I mean no disrespect to the Government but our adversarial system leaves the Opposition with no alternative but to push the Government to do something for the people whom we represent. We cannot work together because there is no forum for us to do so. This is why we must constantly barrack the Government to do some work.
Dr. Twomey: Subventions are an extremely important issue. The eligibility criteria for a subvention was extended in the last budget but it is not the same thing as increasing the rates for subventions. We will continue to press this point until the rules are changed. Between €130 and €190 per week is the maximum subvention to which anyone is entitled. It is not possible to secure a nursing home place costing €190 per week. The cheapest nursing homes probably cost approximately €800 per week in rural areas and up to €1,200 per week in urban areas. This contrasts dramatically with charges levied in 2000. The Minister must acknowledge this and increase the rates. She should stop dillydallying around the value of a house in Dublin or a rural area or stating that eligibility has been increased. She should simply increase these rates to a level that is acceptable for the people involved.
In 2001, the then Minister for Health and Children, gave medical cards to everyone over 70. In 2006, the Tánaiste and Minister for Health and Children announced that €110 million would go towards care of the elderly. However, nothing has been accomplished in respect of care of the elderly between 2001 and 2006.
Dr. Twomey: Comments were made earlier about the €30 million that is supposed to go towards care of the elderly but there is probably €30 million still lying in the bank for the doctor-only medical cards that were to have been issued and there is probably still €30 million in the bank for the ten-point plan announced in the budget. It was promised this money would be spent on the health services but I do not believe it has been spent and believe it is still in the bank, lying next to the €56 million which I hope the Government has found by now.
Going into the next election, the credibility of the Tánaiste and Minister for Health and Children, and that of the Government, will hinge on these issues and their commitment to looking after the elderly. This is why this legislation is so important. There is a raft of legislation lying around dealing with the health service, such as the Medical Practitioners (Amendment) Bill 2002, a pharmacy Bill, a Bill relating to nurses and a Bill regarding the Health Information and Quality Authority. This legislation was promised as far back as 2001. Let us examine eligibility. A range of legislation regarding the rights of elderly people within our community has been lying around since 2001. It is time the Government stopped telling us that such legislation is on its way. These announcements are all we seem to hear from the Government. Even the announcement today by the Tánaiste and Minister for Health and Children about the €200 million for medical education was slightly disingenuous because only €13 million will be spent in 2006. I do not know how she came up with a figure of €200 million but this is a question for another day.
|Ahern, Michael.||Andrews, Barry.|
|Ardagh, Seán.||Blaney, Niall.|
|Brady, Johnny.||Brady, Martin.|
|Browne, John.||Callanan, Joe.|
|Callely, Ivor.||Carey, Pat.|
|Carty, John.||Cassidy, Donie.|
|Collins, Michael.||Coughlan, Mary.|
|Cowen, Brian.||Cregan, John.|
|Cullen, Martin.||Curran, John.|
|Davern, Noel.||de Valera, Síle.|
|Dempsey, Tony.||Dennehy, John.|
|Devins, Jimmy.||Ellis, John.|
|Fahey, Frank.||Finneran, Michael.|
|Fitzpatrick, Dermot.||Fleming, Seán.|
|Gallagher, Pat The Cope.||Grealish, Noel.|
|Hanafin, Mary.||Haughey, Seán.|
|Hoctor, Máire.||Jacob, Joe.|
|Kelleher, Billy.||Kelly, Peter.|
|Killeen, Tony.||Kirk, Seamus.|
|Kitt, Tom.||Lenihan, Brian.|
|Lenihan, Conor.||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’Donoghue, John.||O’Donovan, Denis.|
|O’Keeffe, Batt.||O’Keeffe, Ned.|
|O’Malley, Fiona.||O’Malley, Tim.|
|Power, Peter.||Power, Seán.|
|Roche, Dick.||Sexton, Mae.|
|Smith, Brendan.||Smith, Michael.|
|Treacy, Noel.||Wallace, Dan.|
|Wallace, Mary.||Walsh, Joe.|
|Wilkinson, Ollie.||Wright, G. V.|
|Boyle, Dan.||Breen, James.|
|Breen, Pat.||Broughan, Thomas P.|
|Bruton, Richard.||Connaughton, Paul.|
|Connolly, Paudge.||Cowley, Jerry.|
|Crowe, Seán.||Cuffe, Ciarán.|
|Deasy, John.||Deenihan, Jimmy.|
|English, Damien.||Enright, Olwyn.|
|Gilmore, Eamon.||Gogarty, Paul.|
|Gormley, John.||Hayes, Tom.|
|Healy, Seamus.||Higgins, Joe.|
|Higgins, Michael D.||Hogan, Phil.|
|Howlin, Brendan.||Kenny, Enda.|
|Lynch, Kathleen.||McCormack, Pádraic.|
|McGinley, Dinny.||McGrath, Finian.|
|McGrath, Paul.||McHugh, Paddy.|
|McManus, Liz.||Mitchell, Olivia.|
|Moynihan-Cronin, Breeda.||Murphy, Gerard.|
|Neville, Dan.||Noonan, Michael.|
|Ó Caoláin, Caoimhghín.||O’Dowd, Fergus.|
|O’Keeffe, Jim.||O’Shea, Brian.|
|O’Sullivan, Jan.||Pattison, Seamus.|
|Penrose, Willie.||Perry, John.|
|Quinn, Ruairí||Rabbitte, Pat.|
|Ryan, Eamon.||Ryan, Seán.|
|Sherlock, Joe.||Shortall, Róisín.|
|Stagg, Emmet.||Upton, Mary|
|Timmins, Billy.||Twomey, Liam.|
|Ahern, Michael.||Andrews, Barry.|
|Ardagh, Seán.||Blaney, Niall.|
|Brady, Johnny.||Brady, Martin.|
|Callanan, Joe.||Callely, Ivor.|
|Carey, Pat.||Carty, John.|
|Cassidy, Donie.||Collins, Michael.|
|Coughlan, Mary.||Cowen, Brian.|
|Cregan, John.||Cullen, Martin.|
|Curran, John.||Davern, Noel.|
|de Valera, Síle.||Dempsey, Tony.|
|Dennehy, John.||Devins, Jimmy.|
|Ellis, John.||Fahey, Frank.|
|Finneran, Michael.||Fitzpatrick, Dermot.|
|Fleming, Seán.||Gallagher, Pat The Cope.|
|Grealish, Noel.||Hanafin, Mary.|
|Haughey, Seán.||Hoctor, Máire.|
|Jacob, Joe.||Kelleher, Billy.|
|Kelly, Peter.||Killeen, Tony.|
|Kirk, Seamus.||Kitt, Tom.|
|Lenihan, Brian.||Lenihan, Conor.|
|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’Donoghue, John.|
|O’Donovan, Denis.||O’Keeffe, Batt.|
|O’Keeffe, Ned.||O’Malley, Fiona.|
|O’Malley, Tim.||Power, Peter.|
|Power, Seán.||Roche, Dick.|
|Sexton, Mae.||Smith, Brendan.|
|Smith, Michael.||Treacy, Noel.|
|Wallace, Dan.||Wallace, Mary.|
|Walsh, Joe.||Wilkinson, Ollie.|
|Wright, G. V.|
|Boyle, Dan.||Breen, James.|
|Breen, Pat.||Broughan, Thomas P.|
|Bruton, Richard.||Connaughton, Paul.|
|Connolly, Paudge.||Cowley, Jerry.|
|Crowe, Seán.||Cuffe, Ciarán.|
|Deasy, John.||Deenihan, Jimmy.|
|English, Damien.||Enright, Olwyn.|
|Gilmore, Eamon.||Gogarty, Paul.|
|Gormley, John.||Hayes, Tom.|
|Healy, Seamus.||Higgins, Joe.|
|Higgins, Michael D.||Hogan, Phil.|
|Howlin, Brendan.||Kenny, Enda.|
|Lynch, Kathleen.||McCormack, Pádraic.|
|McGinley, Dinny.||McGrath, Finian.|
|McGrath, Paul.||McManus, Liz.|
|Mitchell, Olivia.||Moynihan-Cronin, Breeda.|
|Murphy, Gerard.||Neville, Dan.|
|Noonan, Michael.||Ó Caoláin, Caoimhghín.|
|O’Dowd, Fergus.||O’Keeffe, Jim.|
|O’Shea, Brian.||O’Sullivan, Jan.|
|Pattison, Seamus.||Penrose, Willie.|
|Perry, John.||Quinn, Ruairí.|
|Rabbitte, Pat.||Ryan, Eamon.|
|Sherlock, Joe.||Shortall, Róisín.|
|Stagg, Emmet.||Timmins, Billy.|
|Twomey, Liam.||Upton, Mary.|
|Last Updated: 04/11/2010 01:43:15||Page of 172|