The Health Service Executive (HSE) is about to conduct a review of how the State's nursing homes are inspected. The body recently said the review would examine whether such inspections were "sufficiently robust".
Since the controversy surrounding the Leas Cross nursing home in Swords, Co Dublin, broke some months ago, critics have suggested the current inspection regime falls down in many areas. There is, for example, no system of inspection for public nursing homes.
The operation of nursing homes is governed by the Health (Nursing Homes) Act 1990 and the Nursing Homes (Care and Welfare Regulations) 1993. Sections 23 and 24 of the regulations cover the inspection process, mostly setting out the obligations of the nursing home staff and proprietor with regard to the running of the premises. Section 24 provides that inspections "shall be made by designated officer not less than once in every period of six months".
However, it recently emerged that some 83 homes were inspected only once last year.
The legislation places obligations on nursing home operators with regard to how their homes are run, but it is less specific with regard to how inspections should be conducted.
It covers, for example, nursing homes' obligations to residents, including their rights to appropriate medical care, their right to privacy and right to information about current affairs and also ... areas such as hygiene, kitchen and sanitary facilities, nutrition and staffing matters.
Paul Costello, chairman of the Irish Nursing Homes Organisation, which represents more than 150 nursing homes providing over 14,000 beds, or 60 per cent of the total, welcomed the review, but said he did not realistically expect legislation until early next year.
He said there was a conflict of interest with the HSE effectively operating as a purchaser of care, as a regulator and as an inspectorate. Costello said his organisation favoured an independent inspectorate along the lines of the Social Services Inspectorate, which inspects care homes for young people.
On the current regulations, Costello said they had "little or no teeth" and that there were no minimum standards set out in them.
"They are not patient-focused enough." The "nuts and bolts" of inspections were also "totally subjective".
In her recently published annual report, the Ombudsman, Emily O'Reilly, said nursing home inspection reports should be made available to the general public as a matter of course. Some health commentators have suggested the reports should be accessible on the HSE's website.
The HSE's review of the system is likely to be taken into account in the preparation of new legislation on the nursing home sector promised by the Tánaiste and Minister for Health, Mary Harney.