OPINION:THE WORST aspect of the Leas Cross episode is not that it took RTÉ television's Prime Timeprogramme to expose what was going on – rather it is that not even Prime Timecould show the worst of what was happening there. We've heard the worst from relatives in the last few days since the publication of the Leas Cross report. Each of the emerging stories carries a lifetime of grief for the relatives of the patient involved, writes TADHG DALY
The systems at the time were deeply flawed. One of the underlying issues around maintaining standards was inspection of nursing homes. Prior to July 1st, 2009, those inspections were carried out by the Health Service Executive (HSE). The HSE, therefore, was provider, regulator and purchaser – a clear conflict of roles.
There was no management around the transfer of a significant number of patients from St Ita’s in Portrane with the priority being cheap beds – and this is something from which we must learn in the future. Transfer of large numbers at one time may makes sense to the system. It doesn’t make sense to the individual patients. It’s vital that the staff at a nursing home have the time to welcome each new resident, learn their likes, dislikes, individual care needs, and establish a warm caring respectful relationship with them.
It’s not about numbers. It’s about individuals.
Each individual who enters a nursing home is different. Some may, with excellent care, physiotherapy or other treatments, recover the capacity to live independently and leave the nursing home, rehabilitated. When it happens, it’s a triumph for the former resident and a great achievement on the part of the nursing home staff.
Another resident may require comprehensive concentrated care. Nursing Homes Ireland (NHI) believes that the delivery of the varied forms of care required by older people demands constant development of skills and methods. In the last number of years, NHI has published a number of documents to assist nursing home operators in the best management and care of their patients. It also provides ongoing training for its members.
For that reason, NHI welcomes the establishment of the Health Information and Quality Authority and has worked closely with the authority on the development of the new National Quality Standards for Residential Care Settings for Older People. We also worked closely with the Department of Health and Children on the new regulations pertaining to them. NHI sees these as critical to ensuring that nursing homes – public, private and voluntary– deliver excellent care in the most appropriate setting.
When Prof Des O’Neill’s report on Leas Cross was published three years ago, he pointed out that it was of critical importance that “the whole of the nursing home sector is not given a bad name because of this bad nursing home”. He said nursing homes across the country have highly committed, professional, well trained staff who are “striving to deliver excellent care.
That is as true today as when it was said in 2006. Nonetheless improvement is always possible and so we must learn lessons from the Leas Cross report.
One regressive move in recent days has been the clear indication that the National Treatment Purchase Fund (NTPF) intends to pursue a one-price-fits-all policy with nursing homes. Price is to be set as low as possible without taking into account the level or differing kinds of care required for individual residents. The reality is that some nursing homes are equipped to manage complex medical needs and disabilities among their residents. It makes no sense not to acknowledge, in payment terms, higher levels of care.
The fund’s one-size-fits all approach, if allowed to continue, will have serious consequences. Some nursing homes will go out of business, and others will be forced to cut costs and resources. This will drive down the quality of care, and the resident will suffer. Minister for Health Mary Harney’s Fair Deal scheme is a major step forward towards ensuring that providing care for older people does not beggar them or their families. It would be a tragedy if it were used by the NTPF as a bargaining tool predicated on the assumption that such care means a bed, a certain number of trained professionals, and nothing more.
The Leas Cross episode should underline the lesson that achieving the best for our growing number of older people requires committed people who like working with older people, requires rigorous and proportionate inspection and requires speedy action to correct any flaws identified. It also requires partnership between the private nursing homes who provide 70 per cent of the available beds and the State systems involved.
The nursing home owners and operators in NHI don’t sell a discount product in bulk. They provide care, attention and respect, backed by the highest nursing standards. We, in NHI have a significant contribution to make in developing those services, so that residential care for our older people is the best that it can be. We have the expertise, the commitment and the willingness to work alongside the Government and all other key stakeholders in the sector to create a service to be proud of.
In the aftermath of Leas Cross, they are understandably furious when the NTPF takes a “yellow pack” approach to the sector which disincentivises operators from responding to individual need by making it financially punitive for them to try.
Tadhg Daly is chief executive of Nursing Homes Ireland, the representative organisation for the private and voluntary nursing homes sector – www.nhi.ie