Oireachtas Joint and Select Committees
Wednesday, 18 June 2025
Joint Oireachtas Committee on Health
Standards of Care, Related Practices and Oversight in Nursing Homes: Discussion
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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The meeting today is to consider standards of care and related practices, and oversight of these matters, in nursing homes. From the Health Information and Quality Authority, HIQA, I welcome Ms Angela Fitzgerald, chief executive, Mr. Finbarr Colfer, chief inspector of social services, and Ms Susan Cliffe, deputy chief inspector.
Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in respect of an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that witnesses comply with any such direction.
Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I understand all members are attending the meeting in person.
The format for the meeting is that we will have an opening statement from the HIQA CEO, after which each member will have an opportunity to ask questions or make a statement. Time will be limited to five minutes per member and we will go on rotation, as agreed. I ask members to confine themselves to the five minutes allocated because time will be tight.
We would all agree that the recent "RTÉ Investigates" programme was very difficult and disturbing viewing. I hope we can shed some light today on what happened, why it came about, what needs to change and the steps we need to take.
I invite Ms Fitzgerald to make her opening remarks on behalf of HIQA.
Ms Angela Fitzgerald:
I thank the Cathaoirleach and members for giving us the opportunity to be here today. As the Cathaoirleach noted, it is a very difficult time for people living in nursing homes, that is, not just the two nursing homes referenced in the RTÉ programme but all such homes. It is incumbent on us to account to the committee and the public for how we do our work, what happened in these cases, what our response is and, critically, what we will do as we go forward.
As a human being, a daughter and a member of society, I reiterate my deep concerns about what we witnessed. The conduct of some staff and the behaviours witnessed were wholly unacceptable in any circumstance. I know, because I have done it for my dad and mam and, more recently, for my father-in-law, that the decision to place a loved one in long-term care is one of the most difficult and emotional decisions a family will make. It involves handing over a loved one to an entity to mind them for their remaining days. Nursing homes are entrusted by families and the wider public to take care of our older citizens, who have made their contribution to society and have a right to be taken care of at this time with dignity and respect.
The RTÉ programme raised shocking and deeply concerning issues, which we will seek to address today. Fundamentally, what we witnessed was a breach of basic human rights that can never be condoned in any circumstances. I recognise that the public and residents may feel let down by the nursing homes and, indeed, by us. We have to account for our role as a regulator, how we do our work every day and how we can do it better as a result of what has happened. I hope we will have an opportunity to explain that to the committee and to account for ourselves.
In circumstances like these, it is really important that there be an immediate response. Our first response must always be to ask whether the residents are safe and what we can do to make them safer in the circumstances in which we find ourselves. I am joined today by our chief inspector, Mr. Finbarr Colfer, and our deputy chief inspector, Ms Susan Cliffe, who have a statutory responsibility of direct accountability to the Oireachtas for carrying out inspections.
They will have an opportunity to explain for us all how that work is carrying on. By way of an immediate response, we conducted immediate unannounced inspections in the two centres over a number of different times: in the evening, early morning and late at night. We will explain later why we did it in that way. We also insisted the owners, who are not the providers, meet with the chief inspector as a matter of urgency to account for what happened and to take action. Both providers were issued with an immediate warning of the potential cancellation of registration if they failed to comply with any actions we required of them. More recently, through engagement with the chief inspector and myself, we agreed with the nursing homes to restrict admissions in all of their nursing homes, which total 23, for a period of four weeks to allow them, in the first instance, to be assured that all is well, but also to allow us to assess their ability to assure themselves. That is an important point which we will come back to today. We are the second line of defence when it comes to care. The first obligation must always be with the provider. In asking them to assure themselves, we will look at what they are relying on in that assurance.
Some of the immediate actions were designed to be immediate. We also need to say that this must be sustained. Ms Cliffe and Mr. Colfer will talk about circumstances in which immediate actions are taken and there is an intervention, but there is a need for a sustained response. This was so serious that we took action to inform An Garda Síochána. We will tell the committee about how we do that in other circumstances. We do it on the back of certain notifications. In this instance, we felt what we witnessed merited that action. An Garda Síochána will take its own action, but this is something we have done. We have also asked RTÉ to give us all of the footage because it may have more information than we currently have. We need to be able to see it to ensure that every resident, not just the people on the screen, are safe. RTÉ has agreed to co-operate with us in this regard and it is hoped it will be able to provide the information we need.
At a time like this, and I refer back again to being a human, Mr. Colfer and I were in the nursing home, and Ms Cliffe and her team carried out inspections there, we took the time to sit with residents and their families. It is important to say that a lot of families had good things to say about their experience. Most of them were anxious about what happens when they are not there and how they will know that all is well when they are not there. We share that concern. We took the time to listen to the lived experience and to observe what it is like to live in a nursing home. It is their home, and we are trying to make sure it feels like home, with all of the safeguards in place.
Emeis Ireland, which is the owner, has co-operated with us fully. It has taken the actions, opened the doors and agreed for us to meet with it on any basis we need. We do not have a legal role with Emeis Ireland. We do not have that role, which is something we will talk about later. Notwithstanding that, it and other providers typically work with us every day. What we want to be able to see, in circumstances where things go wrong, that additional powers are provided. We will come back to that later.
We talk a lot about governance and management. What does that mean? What they simply mean is that providers have systems and arrangements in place to allow them to know their arrangements are safe and they deliver safe, effective care. We have a secondary obligation, which is to assess their systems of governance and management. We do that. Members will see that, in all of our reports, it is something we look to because poor governance is usually an indicator of poor care. What this programme and these events have amplified is the importance of culture. While we look at that as part of our process, it is harder to see. What we saw in the programme is that, where people choose to behave in a particular way, they will not do that when they are being supervised or when we are there. We have to look beyond what we currently look at to see whether we can look underneath the bonnet in terms of governance. Regarding our systems and processes, we look carefully at a range of inputs to give us indicators of that. Ms Cliffe and Mr. Colfer will talk about that. We have to see whether we can do more in this space.
We have talked in the opening statement about how we do that work. While I will not go into further detail here, we will take it through in the questions. We inspect and report against the quality and safety based on both those inspections and on notifications, concerns and protected disclosures. We conduct ongoing monitoring and compliance. We will share that information with the committee. We always engage with residents and seek their feedback directly. While we do all of that, in this situation, we saw what happened. We must, therefore, look at the rail guards we can put between inspections and in the wider sense. Ultimately, it is about how we hold providers properly to account. They want to do that with us and have said as much. We now have to see whether they can do it on a sustained basis.
I wish to talk about the impact of HIQA. I know questions are being put to us today, but I wish to speak to what HIQA has done in the past 16 years. Even in the debate, people have acknowledged that. We know we have contributed to making a real difference in people's lives. People tell us that directly. We want to be able to continue to do that. We always want to challenge ourselves to not sit still, but rather to move forward. This is a big challenge we are facing, but we must be open and willing to accept that challenge.
Most providers respond promptly and efficiently. We welcome the fact they take their responsibility seriously. Where providers do not respond, we have levers, which we will talk more about today. They include issuing warnings, following up with inspections, engaging with providers, seeking more information and, ultimately, cancelling registration. That is a big decision. It impacts lives. In the case of Beneavin nursing home, 70 people call it their home, of whom many say they are happy there. It is a decision we have to take carefully, but we cannot stand over a situation where there is unsafety . Where we see unsafety, either through our inspections or otherwise, we act immediately. We will talk more about that.
With regard to the two nursing homes, it is important to say that we identified issues regarding training, staff, supervision, governance and management. Our typical approach is to allow the provider some time to improve their performance. That is part of what the regulation does. We have done that in this instance. We will come back to that. It is important to say that there is a slight difference between the two centres. One centre showed weak, underdeveloped management. The other centre showed an issue with culture and behaviour. They are two different things which demand different responses. We will talk to the committee about that.
When it comes to the regulatory framework and what needs to change, we have advocated publicly in written form for changes. We identified changes that need to be made. Many of those have been made, such as to our enforcement powers, the time to give effect and our power to investigate individual complaints. We will talk about those aspects throughout this meeting today. A particular change is the power to seek information on an ongoing basis. While that may seem like a basic requirement, there were some restrictions on us and that is now changing, and that will give us more powers. We have examined, with the Minister and others, what else we need to do and we will come back to members during today's meeting in this regard. One aspect relates to the corporate entity we talked about.
We need to look at our ourselves. We need to ask how we can be better in this space and what we can do. We must work with providers to require them to look at how they co-ordinate clinical care so that they know every day that Angela, her mother or anyone else is safe. We must use the safe staffing frameworks. Staffing was an issue and we welcome the work the Department is doing in safeguarding and staffing. The safe staffing framework has been implemented in acute hospitals, which is giving us an objective lens.
We need to look at how we look under the bonnet. What else can we rely on? We have some thoughts which we will share with the committee today. Fundamentally, we would like to say we are really sorry to the families directly impacted and to the wider community. We know they feel they have been failed by the nursing home and, to some extent, by us. We want to be answerable for that and we want to work with them to make it better. We are open to hearing their questions and challenges to us.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Ms Fitzgerald. We will now move to members, who will have five minutes each. The first slot is for a member of Fianna Fáil. I call Deputy Daly.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the witnesses for attending today. It is really appreciated. It is critical we get answers to what has happened in the Emeis nursing homes, in Beneavin nursing home and in The Residence, that was exposed by “RTÉ Investigates”.
Rather than rehash the emotional horror many felt on watching what was, in the words of one of the specialists in elderly care, “elder abuse”, with which analysis I do not believe anyone has disagreed, we should ask how we can put this right and reflect on what has happened and been exposed so as to improve things. I have a series of questions. Rather than listening to myself speak, I would prefer to get some answers, if I could. Is the regulatory framework for nursing homes adequate? How can it be strengthened? Is there overreliance on the private provision of nursing home care, on which we have become dependent, and on having an ever-increasing congregation of elderly people in private nursing home facilities, which I am told is the only way to make them viable? Is there adequate funding going into the nursing homes to provide adequate care? Has HIQA a role regarding staffing levels?
One of the main findings in the interim report is that there are really serious concerns not only about the care of patients but also about the facilities in which the care was being provided. In The Residence, there were something like 40 abuse complaints and there was an issue with fire regulations and control. Most other buildings in the country would be closed down by a fire officer if there were a non-compliance rate with fire regulations of 100%, as was the case in The Residence. In Beneavin, there were 198 complaints of elder abuse between 2022 in 2024. There was non-compliance with the rights of residents in respect of personal care, record-keeping, premises and infection control. The list goes on. What does it take to close down a nursing home? Has HIQA any powers to impose financial penalties on corporations that feel they are unencumbered by HIQA in providing the services they provide? It does not look like their behaviour changed until they were exposed by “RTÉ Investigates”.
Ms Angela Fitzgerald:
I thank Deputy Daly. There are two points to make on our powers. First, the powers we have allowed us to take action with the provider. Ms Cliffe and Mr. Colfer can speak about how we execute those powers.
On the question on the move towards large corporate entities, we agreed that it is a shift. We currently do not have powers to direct or require them to do anything. We work on the basis of co-operation. I want to put on record today that the vast majority of the corporate entities and individual providers co-operate and work with us. The regulations are to provide action and a deterrent. It is important, when there is a changing landscape, to pause to consider whether we need additional regulatory powers in circumstances such as those in question to allow us to hold the entity to account. The action by the entity itself to restrict all admissions to all units, based on discussion with us, is one we welcome, but it might be one that we would require of a corporate entity. That is an example of where having the powers would be very important.
One can see in all our inspection reports that we comment on staffing, but we do not have a standardised framework for determining what good staffing looks like. The work being done on healthcare by the Chief Nursing Officer will give a much more objective lens and allow us to comment much more forcibly where we need to. More important, it will require providers and owners to be bound by the staffing frameworks in a way that they are not currently. The safe staffing framework has two roles: giving the power to us to appraise and critique; and being able to challenge the provider.
Pádraig Rice (Cork South-Central, Social Democrats)
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That is the end of the time slot.
Pádraig Rice (Cork South-Central, Social Democrats)
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There will be another slot in which Ms Fitzgerald can contribute.
Martin Daly (Roscommon-Galway, Fianna Fail)
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That is fine. I thank the witnesses.
Pádraig Rice (Cork South-Central, Social Democrats)
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We are tight on time this morning. The next slot is for Sinn Féin.
David Cullinane (Waterford, Sinn Fein)
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Did “RTÉ Investigates” send a letter to HIQA 12 days before the programme aired setting out questions?
David Cullinane (Waterford, Sinn Fein)
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Was it prior to the programme being aired?
David Cullinane (Waterford, Sinn Fein)
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When Ms Fitzgerald said in her opening statement that until the programme aired on 4 June 2025, HIQA was not aware of the full detail of what was found in the footage, she was not correct if RTÉ had set out in a letter very detailed questions concerning issues it found in its investigation for its programme.
David Cullinane (Waterford, Sinn Fein)
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That is not what Ms Fitzgerald said; she said she was not aware of the full detail of what was found in the footage. What was in the footage-----
David Cullinane (Waterford, Sinn Fein)
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With respect, Ms Fitzgerald should bear with me. What was in the footage was outlined in the letter sent by “RTÉ Investigates”.
David Cullinane (Waterford, Sinn Fein)
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When Ms Fitzgerald says HIQA had no sense, she should note that the two healthcare assistants who went undercover also made protected disclosures. In fact, they had two phone calls with HIQA, one that lasted 40 minutes and one that lasted 25 minutes. This was a month before the programme aired and, again, all the issues were set out. Therefore, with respect, it is not accurate at all for Ms Fitzgerald to say HIQA was unaware of the issues when the programme aired. The whistleblowers met HIQA and all the issues were set out in phone calls. Is that not correct?
David Cullinane (Waterford, Sinn Fein)
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No, I am asking Ms Fitzgerald the questions. I am asking very direct questions because the matter is important. Did the two healthcare assistants who were part of the undercover programme speak to HIQA in advance of the programme being aired?
Ms Angela Fitzgerald:
What I have to say to the Deputy is that we cannot discuss that. First of all, anyone who spoke to us would not have been identified as a healthcare assistant. They would not have identified themselves in the manner in question. We get protected disclosures all the time, and any protected disclosure would have been dealt with. There was extensive discussion. All the protected disclosures relating to the two centres are dealt with. We cannot discuss who made them. The individuals would not have been identified as described and we do not know that they were the individuals from RTÉ, but what I can say-----
David Cullinane (Waterford, Sinn Fein)
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They made HIQA aware of the issues, however. I wanted to set that out very clearly at the start because accountability is important and families feel very let down by HIQA, as a regulator, and the Government. I have spoken to many of them.
I want to ask Ms Fitzgerald about the changing nature of nursing homes because we now have what I would consider to be a large number of multinational companies operating in this space. The multinational in question, Emeis, is a very complex legal entity, with 25 nursing homes and 19 companies. Does regulating Emeis as a corporate body, as opposed to the individual companies, present a challenge to HIQA?
Ms Angela Fitzgerald:
It is a fair question. I have touched on it already but I am happy to elaborate. What I have said before, on which I might ask Mr. Colfer to contribute as required, is that we have the powers to regulate the provider. With respect to the corporate entities, we do not currently have any powers to require them to take action or to impose regulatory action on them. To put it into context, there are 23 nursing homes owned by Emeis and we have to apply sanctions or actions to each in response to something that may be at corporate level. In this instance, Emeis has stepped up and agreed to take the action. To answer the Deputy’s question, it is important that we have additional powers so that, in circumstances where we need to act with the corporate entity-----
David Cullinane (Waterford, Sinn Fein)
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Take the case of Dublin, Beneavin. According to HIQA’s interim report published yesterday, there were 198 allegations of suspected or confirmed abuse of a resident there. This is shocking. What financial penalties have been imposed on any of the individual homes or the corporate body, given all the issues that have been raised? It is a straight question and I want a straight answer.
David Cullinane (Waterford, Sinn Fein)
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What financial penalties have been imposed?
David Cullinane (Waterford, Sinn Fein)
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So, none. With respect, what we saw in a programme was cost-cutting by a corporate body leading to a neglect of residents. Families feel very let down. The quality of care was substandard. It was clear to me that this was about a corporate body trying to save money and cutting costs. HIQA has no powers to impose any financial penalties whatsoever. Is that correct?
Pádraig Rice (Cork South-Central, Social Democrats)
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The Deputy's time is up.
David Cullinane (Waterford, Sinn Fein)
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The question can be answered quickly with “Yes” or “No”.
David Cullinane (Waterford, Sinn Fein)
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Does Ms Fitzgerald think HIQA should have them?
Pádraig Rice (Cork South-Central, Social Democrats)
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That is time. We want to ensure that all members get in fairly. We have allocated five minutes for members and we encourage members to stick to that.
Peter Roche (Galway East, Fine Gael)
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It is important that we address the issues presented by RTÉ. Despite the failings of RTÉ in the past, it has done a remarkably good job bringing this to light. It was not pleasant viewing, as I understand. I did not see it myself. I saw the images advertising the “RTÉ Investigates” programme.
I have had the benefit of visiting quite a number of nursing homes. Some of them are run extraordinarily brilliantly, with extraordinary staff. It would be wrong of us to think that there are failings in every nursing home. I have to say that to be fair and honest.
One of the things that always concerns me is when hearing stories about the difficulties some nursing homes have with recruiting staff. One can sometimes employ somebody who would be seen to be doing a good job but who may not be in any way suitable for a position that requires him or her to be empathetic and sympathetic and to fill a caring role. I suspect that nursing homes sometimes just feel that such persons might fill that gap "for now". If the employee is not suitable, that is where there are issues.
Respectfully, are visitations conducted by HIQA unannounced rather than prepared like one would do for any inspection? It one gets the heads up, of course everything will be grand. It is the same as if it were a ministerial visit or any other visit. It is important that there be random, unannounced visitations. I was going to suggest that nursing homes be monitored with CCTV. That probably would be an invasion of privacy, a breach of GDPR and all that kind of stuff.
One of the things we need to ensure is that we never again see something like this or hear about the level of abuse in nursing homes that we did in this programme. The only way to do that is to make sure there are strict guidelines and strict policing in terms of the type of people employed and their suitability to do the job. No matter what position is available, people should be interviewed for their suitability for the position. It is my gut feeling that one of the things that probably has happened as a consequence of the difficulties in employing suitable staff is that nursing homes may often have no other choice but to employ people who want a job rather than want this specific job in the caring field.
I would like to think that somewhere in the future there will be unannounced visitations. In other words, rather than RTÉ finding out, HIQA inspectors or some form of police would be the first to identify if there were some failings or shortcomings.
It really upsets me and everybody else when we hear of the cases of neglect where people were left unchanged for long periods and all that kind of stuff. It is tormenting when one hears that some people suggest they made contact with HIQA and HIQA asked whether they had contacted or made a complaint to the nursing home. It is a case of asking my brother if am I a liar. The nursing homes are sure to tell their side of the story. The policing needs to be there. That is the only way we can get a result that ensures that nursing homes are managed and the patients are cared for. As Ms Fitzgerald referenced, when people are left in a nursing home, it must replicate where they came from, that is, home, where their every need is met with dignity and respect. If they do not get that, then it should lose its title as a nursing home.
Pádraig Rice (Cork South-Central, Social Democrats)
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If members want witnesses to respond to their remarks or questions, they have to leave time for that as well. That is included in the five minutes. We can come back to it afterwards. Members should bear that in mind.
The next slot is for the Social Democrats, which is my time. I will pick up on one of the earlier points about sanctions. Ms Fitzgerald said that HIQA did not have the ability to level fines. Is that correct?
Ms Susan Cliffe:
Our regulatory framework does not include the use of fines. We generally keep it in the space of engaging with the provider, escalating through a process, cautionary meetings, warning meetings, additional restrictive conditions to the provider's registration, and cancellation being the nuclear option. We try to direct the regulatory action towards the improvement that is needed on the ground, which is why we saw stopped admissions to Portlaoise on foot of all the information we had about that centre and the findings of our own inspections. There has been much critique about how we do not use information that we have received. We use every bit of information we receive. In fact, some sectors critique us for the use of what they would call unvalidated information, which is, for example, members of the public, relatives and so on.
Pádraig Rice (Cork South-Central, Social Democrats)
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Am I right in thinking that the ultimate is forced closure?
Pádraig Rice (Cork South-Central, Social Democrats)
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What then? HIQA has forced the closure, but what sanctions are beyond that if there are not fines or repercussions for the providers? Can a private provider then just reopen in a different location? Does HIQA make referrals to the Garda? Has it done that in the past? Does HIQA need powers beyond that? Does it need the power to have sanctions around fines and forcing somebody not to be able to operate or a private provider not to be able to reopen?
Ms Susan Cliffe:
We have the power to regulate each individual nursing home vis-à-vis the company that runs that nursing home. What we are talking about at a higher level is if we would have the powers to go above that, to the company that owns all of these companies. That is what does not currently exist. The Minister has discussed with us where we can move into that space to reflect the changing landscape that is in the Irish sector.
Pádraig Rice (Cork South-Central, Social Democrats)
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HIQA needs additional powers to regulate those companies above the companies-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Separately, the concern many people had was that, if I am correct, Beneavin Manor was found largely compliant in November 2024. Is that true? We then had the RTÉ programme, which exposed serious and grave concerns. How did that happen?
Ms Susan Cliffe:
Both are true. We stand over the findings of the inspection in November. However, what we can see now from looking at the information that we have is that, since we were there in November, the home recruited 75 additional staff, 35 staff members moved on, the occupancy rate increased and the number of residents who were admitted with what we call additional responsive behaviours, which require 24-hour, 1:1 supervision, went from six to 18, I believe. The profile of that nursing home changed completely between when we were there in November 2024, reflecting the findings of our inspections, and what we saw. What was really upsetting about what we saw was how many times we heard people say things like, “This is not the way to do it”, “Close the door, we do not want them to see us doing it like this”, and “We should not be doing it like this”. It was not a failure of training or knowledge. It was a failure of supervision. That is the space where we are engaging with the registered provider on this matter, namely, its day-to-day supervision and oversight of care.
As regards the management structure in Beneavin Manor, the person in charge and two assistant directors of nursing, many of the senior people, left between December and January.
Pádraig Rice (Cork South-Central, Social Democrats)
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Just so I am correct, your contention is that you stand over the inspections and there was not a particular failing-----
Pádraig Rice (Cork South-Central, Social Democrats)
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You do not think there is a failing in the inspection model.
Pádraig Rice (Cork South-Central, Social Democrats)
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There is a sense that concerns were raised and protected disclosures were made but it took the airing of a TV programme to get an adequate response. That is a contention.
Pádraig Rice (Cork South-Central, Social Democrats)
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Concerns raised by whistleblowers and protected disclosures were not taken seriously enough, and it took RTÉ exposing this for us to get an adequate response. We have just 20 seconds left, so we might get a quick response.
Mr. Finbarr Colfer:
Regarding our inspections, there are a number of things that are important to bear in mind. One is that meeting regulatory requirements is the basic minimum requirement. In the centre in question, what we did find was it had a troubled regulatory history. It was putting measures in place to address that, and when we went out in November, our inspectors found that those measures had started to be put in place. What we found when we went back out on inspection recently was there had been a complete change.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will move to the next topic. We can return to this again. Our next speaking slot is for Fianna Fáil. I call Senator Costello.
Teresa Costello (Fianna Fail)
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My first question relates to routine inspections. I am interested in whether, prior to this, routine inspections were carried out during the night or at different hours and without prior knowledge that this would happen?
I see the witnesses refer to the testimonies of patients and their families. Patients’ families were being lied to. They were told their parents were being brought on walks and cared for. I question the validity of the testimonies of patients and their families. Patients who have dementia will also state they are fine when they are not. It angered me when I read in these documents that patients said the centre was okay, and they were happy with how they were cared for. That annoyed me. I am no expert but I know if a dementia patient told me they were okay, I would check to see physically. Do inspectors physically look at these patients? Do they see the hygiene standards?
Also, with regard to the provider, I assume it was paid and collected money for caring for these patients, and I am sure it was prompt with that. Yet it could not keep proper stock of the level of incontinence products available for patients. I find that unbelievable. When HIQA carries out inspections, does it look at stock levels of vital products? There was a book written about this particular organisation and its strategy. Its cost-reduction strategies included low pay, illegal use of temporary contracts and rationing of food and hygiene products, which leads me back to the lack of incontinence products. This removes people's dignity.
The trust is gone for people. A constituent of mine rang me. This is a healthy, 70-year-old man who said, “God bless me if I ever need to go into a place like that.” The fear that has torn through our society is unbelievable.
The inadequate staffing levels of the facility have often been raised. Should a facility not be put on hold when there are not enough staff to do the job? Is the company confident it can operate? It is definitely getting the money to carry out the work.
Teresa Costello (Fianna Fail)
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Could Ms Fitzgerald deal with the validity of the patient and family testimonies? Those people were being lied to.
Ms Angela Fitzgerald:
It is a very fair point. Mr. Colfer and I spend quite a bit of time meeting families who spend every day, such as one man we met who visits his dad every single day. His sisters do a rota every evening. Their concern is what happens when they are not there. They were very satisfied with what they saw, but they have a confidence issue. It is a fair point the Deputy raises. Whatever about dementia patients, and my mother had dementia, what I can say is that it is important we do not dismiss the voice a dementia patient has, but we have to have additional rail guards to ensure there are other checks. The Senator has put her hand on a very important point that both Mr. Colfer and Ms Cliffe will come in on.
As regards the point Deputy Roche made which the Senator also picked up on, which is the qualifications people have, there are no minimum qualifications for staffing. Deputy Roche made the point that in a difficult environment, you take the person you can rather than the person you should. That is the responsibility of the provider. We have asked the Minister to look at qualifications being mandatory. The State staffing framework will give us much more weight to raise those questions.
As to the Senator’s point about families being hurt by this, I absolutely get that. There is nothing we can say today to change that. It is going to take time and action by nursing homes and by ourselves and it is going to take additional powers. However, there may be a couple of specific points the Senator made that-----
Pádraig Rice (Cork South-Central, Social Democrats)
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You have ten seconds left.
Ms Susan Cliffe:
We do reflect the voice of the resident. All our reports start with the voice of the resident. We understand the limitations of some people's basic underlying health conditions, but there are many people living in nursing homes who have clear cognition and can very well reflect the day-to-day routine and the impact it is having. We have met with all of those and we do try to reflect their voice. It is equally important, and we look to see, that the providers have systems in place to hear the voice of all residents, and not just those who can speak up. We have met the full gamut of responses while we have been in Beneavin and Portlaoise for three days each in the past while. Some relatives and families are very satisfied with the care they receive while others have concerns. Others express their disappointment in HIQA as well. We have heard the full gamut of responses.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Initially, I have to say I am absolutely horrified that HIQA representatives would come in here and say that RTÉ has more information than they do. You are the regulator of nursing homes. You are the people families put their trust in. That is beyond my scope of understanding, how you can say that to an Oireachtas committee.
I do not accept the explanation the witnesses provided earlier as to how HIQA stood over a substantially compliant report on nursing homes. They acknowledged there was significant change in staff and a difference in profile. Why did they not go back? That is one of my questions. I want to finish my questions first, because we do not have a lot of time.
Given that Beneavin in particular recorded almost 200 abuse notifications, why did HIQA not escalate these to potential systemic failures earlier? Why was An Garda Síochána not involved until after the "RTÉ Investigates" programme, and would the Garda ever have been involved if it had not been for the "RTÉ Investigates" programme? How many staff are working with HIQA as inspectors or in any other area that were previously employed by these nursing homes?
Ms Angela Fitzgerald:
The point we made about the profile of staffing change was between one inspection and the other. There is a question for us about the routine information we receive between inspections that alerts us and requires providers to alert us about material changes. That is a regulatory change that is now being implemented. It will allow us to know how many people are on the ground every day because, at the moment, we request information in advance of inspections as part of our inspection process.
However, very specific routine information coming through about staffing levels, staff turnover and the issues we have raised here will strengthen our pieces. The Garda is notified. I will ask Ms Cliffe to explain the notifications that come in and which have been referred to because it is a really important point.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I am conscious of time. I have just over two and half minutes.
Ms Susan Cliffe:
A high number of notifications is not necessarily a sign of a poor service. It can be a sign of a very responsive service. What we are looking at is the content of the individual notifications. We find that those particular nursing homes report absolutely everything. If there was accidental contact between two people in a communal area, a notification would be sent in.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Of the notifications that have gone to the Garda, why did this only happen after the RTÉ documentary aired? Why did it not happen prior?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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HIQA was aware but it did not notify the Garda until after the broadcast.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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And what RTÉ is broadcasting, clearly.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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The evidence would say otherwise.
Ms Susan Cliffe:
At the time it is received, we review the information in the notification, what needs to change in a nursing home, how the provider has addressed it and what the impact has been on the resident. If we require additional information, we can look for it. We can follow up on each of those individual notifications when we go out to the centre. These nursing homes have a good record of notifying us of any incidents. We have never gone out and found any information that should have been notified to us that was not. They have a low bar for notifying, which is what has contributed to the number of notifications received.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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On my final question, how many HIQA staff were previously employed in nursing homes that now have referrals to the Garda?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Will HIQA submit that information to the clerk of the committee?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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And the level those individuals are working at within HIQA.
Colm Burke (Cork North-Central, Fine Gael)
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I apologise for not being here for the witnesses' presentation. I was dealing with an issue in the Dáil Chamber. On the concerns raised by RTÉ, the most frightening thing for everyone who saw the programme was the treatment of patients and the whole lack of communication. HIQA's report refers to monitoring notifications received in respect of The Residence, Portlaoise. It says 40 complaints were made regarding allegations of suspected or confirmed abuse of residents. When were those complaints raised? HIQA says there were 40. Over what period of time were those complaints made?
Colm Burke (Cork North-Central, Fine Gael)
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Since the centre opened, there have been 40 allegations of abuse of patients.
Colm Burke (Cork North-Central, Fine Gael)
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Who were those allegations made to?
Colm Burke (Cork North-Central, Fine Gael)
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Some 40 allegations were received. I presume they were spread out over that entire period of time. Did that not raise alarm bells?
Colm Burke (Cork North-Central, Fine Gael)
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Still, HIQA did nothing in terms of really decisive action prior to the "RTÉ Investigates" programme.
Colm Burke (Cork North-Central, Fine Gael)
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Did the "RTÉ Investigates" investigation take place after HIQA took that action?
Colm Burke (Cork North-Central, Fine Gael)
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That is a really short period of time in which to receive that number of complaints compared to other nursing homes. The filing of any complaint is serious but 40 being filed is really serious. There would be nowhere near that number of complaints in a 12-month time period compared to other nursing homes.
Mr. Finbarr Colfer:
If I may explain, notifications are required by law on the part of providers to tell us of specific events that happen. They are not so much a complaint as the provider telling us. Some providers report a lot of issues. They will report when two residents have an altercation or if one resident speaks to another resident. When we looked at the notifications for these centres, the majority related to interactions between residents. All of the notifications-----
Colm Burke (Cork North-Central, Fine Gael)
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But still it would raise a concern that this happened over a very short period of time.
Colm Burke (Cork North-Central, Fine Gael)
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I will move on to Beneavin Manor. HIQA states there was 66.7% non-compliance in respect of governance and management. At what time was that identified as being an issue? Was it before "RTÉ Investigates" went in or after?
Colm Burke (Cork North-Central, Fine Gael)
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HIQA is saying that the governance is 66.7% non-compliant.
Colm Burke (Cork North-Central, Fine Gael)
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That was before "RTÉ Investigates" went in.
Colm Burke (Cork North-Central, Fine Gael)
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Was HIQA not concerned that 66.7% is a really high figure and shows a total lack of governance? Is there not a huge risk to residents in that scenario?
Pádraig Rice (Cork South-Central, Social Democrats)
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I ask that Ms Cliffe keep her response brief because we are out of time.
Ms Susan Cliffe:
Governance and management structures are key. In the case of Beneavin Manor, we had serious concerns, which led to the inspections that took place in July 2023 and January 2024. When we went back out to check to see if the centre had followed through on its commitments to address the issues in November, we found that things had improved. All of these inspections were unannounced. That question was raised. Some 85% of all our inspections were unannounced, as were 91% of inspections in Emeis Ireland centres since 2022. They do not know we are coming. We found improvements but that governance structure broke down after our inspection in November. At that time, there was also significant recruitment of staff, the loss of staff who were established in the centre and an increasing dependency of residents.
Marie Sherlock (Dublin Central, Labour)
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I thank the witnesses. It is important to state that HIQA should not underestimate the anger and concern of the public. As an organisation, HIQA has been trusted by the public but that trust has been seriously dented. I have a series of questions. I ask for brief answers in light of the short time we have. Who has been referred to An Garda Síochána? Is it the registered provider or the staff?
Marie Sherlock (Dublin Central, Labour)
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Is there any situation in which the registered provider is referred to An Garda Síochána? Is it ever held responsible for what happens in its home?
Marie Sherlock (Dublin Central, Labour)
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HIQA refers the staff, not the registered provider.
Marie Sherlock (Dublin Central, Labour)
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And it is directed to the staff in this regard, who will be held accountable.
Ms Susan Cliffe:
The provider of the nursing home and the name of the nursing home are the two entities we include in our referral to the Garda, advising it of an event that happened in the nursing home. The specific details and investigation of that event rest with the Garda. We would not know from there where that action would go.
Marie Sherlock (Dublin Central, Labour)
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Clare Doyle, the whistleblower, made a series of protected disclosures along with a number of others. I understand one nursing home that was not subject to the "RTÉ Investigates" programme was part of her protected disclosures. What actions has HIQA taken with regard to her protected disclosure and that nursing home? There is a lot of attention on residents and Beneavin Manor because it has been publicly covered. I do not mean just the umbrella look at Emeis. What actions has HIQA taken on that third nursing home on foot of her specific protected disclosure?
Ms Susan Cliffe:
We are pulling together the regulatory history of all of the designated centres that sit under the Emeis umbrellas. We are reviewing that information. We have also started a programme of inspection of all Emeis nursing homes. We do not have a protected disclosure that has not been investigated within 16 weeks in Portlaoise or Beneavin. We are looking through the totality of the information we have. It is important people know we respond when we get information.
Marie Sherlock (Dublin Central, Labour)
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I am hearing that the third nursing home about which Clare Doyle made a protected disclosure has not actively been investigated by HIQA or investigations have not been completed at this point.
Marie Sherlock (Dublin Central, Labour)
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I have not named the nursing home; I am asking HIQA. HIQA got a protected disclosure with very specific details. Has it acted or not?
Marie Sherlock (Dublin Central, Labour)
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Beneavin Manor nursing home was referred to as having a "chequered history" in terms of issues arising in 2021, 2023 and now. What has HIQA done on foot of non-compliance with fire standards? If there is an issue on a building site, the Health and Safety Authority has powers of immediate intervention, as does the Food Safety Authority of Ireland. From HIQA, I hear a very slow pace of reaction on foot of an immediate and very serious risk to patient safety. The non-compliance with fire standards did not just happen yesterday or last week. It has been there for a period.
Ms Susan Cliffe:
Non-compliance with fire standards in Beneavin Manor is largely restricted to the systems it has in place to recognise and respond. They are not structural issues. Where there are structural or building issues that inform fire safety, we refer them to the fire authority or require a registered provider to give us a plan for how it will address those issues. Non-compliance with fire standards that can be addressed through evacuation processes, aids and the number of dependent residents in compartments can be dealt with quickly by a registered provider. It is our expectation it will do that.
Marie Sherlock (Dublin Central, Labour)
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But Ms Cliffe is saying patients are not safe at this point in time if a fire was to break out in that residence.
Ms Susan Cliffe:
We need to be assured that staff have the skills to deal with a fire in any nursing home at is arises. We have accepted the registered provider's compliance plan for the action it plans to take with regard to addressing the issues raised regarding fire safety in that nursing home. They are not structural issues, which is the kind of issue we would refer to a third party.
Michael Cahill (Kerry, Fianna Fail)
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I welcome HIQA witnesses. What we have seen in recent weeks has left many of us shaken. The "RTÉ Investigates" programme exposed a level of suffering and neglect no resident in any nursing home should ever endure. These were not isolated incidents. They reflect systemic issues. We are here today because the Irish public has serious and legitimate questions. They are demanding real answers. Poor care, mistreatment or abuse whether through neglect or inaction are entirely unacceptable. It is the job of this committee to ensure the systems, regulations and oversight meant to protect residents actually function. HIQA was established to be that safeguard. Today, we must evaluate if that safeguard is still working or if, as many now fear, it is failing the people it was designed to protect.
I will begin with questions on safeguarding and protected disclosures concerning referrals and decision-making. What proportion of serious concerns reported to HIQA are referred to adult safeguarding teams and to An Garda Síochána? Will the witnesses elaborate on the specific process and criteria used to determine if a concern merits referral? What expertise do those making these critical referral decisions have? Is there direct oversight from a safeguarding social worker or another qualified professional? How often has HIQA taken immediate action following a serious concern being raised? What percentage of protected disclosures made to HIQA are fully investigated and by what process? These are not abstract questions; they are about real lives and the protection of the most vulnerable.
To the issues of governance and legality, HIQA has spent nearly €13 million on agency staffing since 2014. Will the witnesses provide a clear breakdown of how many current inspectors are HIQA employees versus agency agents? What roles are agency staff currently fulfilling? Are agency workers carrying out functions legally reserved for direct HIQA employees under the Health Act 2007? Has HIQA reviewed the long-term impacts of agency dependency on institutional knowledge, staff continuity and regulatory consistency? In regard to leadership appointments, there is confusion around the appointment of the current chief inspector. HIQA's own website listed conflicting information well into 2025. Will the witnesses confirm this appointment was formalised and whether both Ministers signed off as required by law? Why did the title change retroactively to chief inspector designate? On financial oversight and ICT expenditure, HIQA has spent €22.8 million on ICT services since 2014. Will the witnesses detail which projects or improvements this spending has supported? How do these ICT investments relate directly to HIQA's core regulatory role?
Pádraig Rice (Cork South-Central, Social Democrats)
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I remind the Deputy his time is for witnesses to answer as well. He will need to give them some time to respond. There is only one minute and 40 seconds left.
Pádraig Rice (Cork South-Central, Social Democrats)
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The Deputy can continue but he has only one minute and thirty seconds left.
Michael Cahill (Kerry, Fianna Fail)
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I will finish while I am in full flight. Were conflict of interest safeguards in place when contracts were awarded to firms linked with former HIQA board members? In regard to transparency, will HIQA commit to publishing all board minutes, procurement, reviews and audit findings related to agency staffing, governance and ICT spending? There was a subsequent programme on RTÉ. It gave the impression of putting out a front regarding inspections. There was a reference to falling asleep, to be sure to be awake at night in the event of inspections, and that things would revert back to normal when the heat passed. I am extremely concerned. Will there be any change? I said before at meetings a very good friend of mine passed away recently.
He said to me once, "If you hear I am being put in a nursing home, please shoot me". Those words came roaring back to me after what we saw on national TV recently. Our senior citizens deserve better. They have worked hard and they deserve better. They are afraid of going into nursing homes. We are all afraid now.
Finally, I requested that representatives of those companies would be invited before the committee. Private companies account for 10,600 beds today-----
Pádraig Rice (Cork South-Central, Social Democrats)
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That is the end of the Deputy's time.
Michael Cahill (Kerry, Fianna Fail)
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Surely, they should be in before this committee.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Deputy. I remind members that in the interests of fairness, if they are going to pose questions to the witnesses, they allow time in their slot to answer those questions. I said that at the start. There is no time remaining in that slot for the witnesses to answer those questions. In the interests of fairness, we need to allow the people we have invited in time to answer the questions we put to them.
That is the end of that slot. Our next slot is Sinn Féin and Senator Ryan.
Nicole Ryan (Sinn Fein)
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Ms Fitzgerald mentioned culture as one of the issues in her opening statement. Does she think four weeks is enough to stop admissions to fix something like culture in these nursing homes? Culture goes beyond four weeks.
Ms Angela Fitzgerald:
The action being taken by Emeis is an action it has agreed as an initial step. We as HIQA reserve the right to require it to take further action if required. The interpretation of the four weeks is an initial step. We have yet to take our own regulatory actions. That is an action taken for the company to assess where things have gone wrong and whether things are okay in other centres.
I am glad the Senator raised culture. It is at the heart of what we have seen and heard from Deputies and Senators today. One of the questions Deputy Clarke asked was how had RTÉ found what we had not. I would not like as a result of this that there would be a decision to use CCTV or go undercover to assure ourselves. We should never have to do that and if we are at that then the systems have failed.
Ms Angela Fitzgerald:
If I may finish, the point I want to make is what we want to ask and require of providers is that they are on the floor every day in their nursing homes assessing how care is being delivered by their teams and that that goes beyond basic duties of care. It goes to kindness, empathy, support and understanding that certain clients who suffer with sundown need to be minded in a particular way at the end of the day. We saw some evidence of that when we went out on inspections and on site visits but that has to be what drives people every day. Many of our nursing home providers and staff come from that place but we have to make sure when we are not there and the members are not here and we are not looking at TV that what drives providers and staff are those values.
Nicole Ryan (Sinn Fein)
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Exactly and in an ideal world that would work but we have seen that in this case this has not happened, especially what was on RTÉ. We were talking about Emeis and how it has engaged. Of course it has engaged. It has been called out in public on national television. It has no choice but to engage at this point -----
Nicole Ryan (Sinn Fein)
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-----because the outrage is huge around this. The question the public has now is: what does HIQA actually do? If the authority does not have powers to enforce anything, what is the point of HIQA in any aspect of this kind of stuff? Ultimately, these are people, residents and human beings who are working towards the end of their lives and they deserve dignity. Deputy Burke said there were 14 notifications. Of those 14 notifications, there was one to say there was abuse because it was not just interaction between residents at all times.
My final question is: how many private nursing homes are currently under active restriction or monitoring by HIQA and on what grounds?
Ms Susan Cliffe:
I have it here. It is about 38 nursing homes that have additional restrictive conditions. We did produce it. A total of 95 nursing homes that have additional restrictive conditions as at 1 June. That was on 5 June when we pulled those figures. Conditions go on and go off depending on action that is taken by a provider. At any time we would pull that and update that data.
Nicole Ryan (Sinn Fein)
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How many of those are corporate entities?
Ms Susan Cliffe:
Of those, 30 are stand-alone centres and 69 are of the conditions are on HSE centres. The majority are not corporate entities. They are not the bigger groups if that is what the Senator means by corporate entities. Of the centres with a condition, 52 are HSE, one is a HSE-funded section 38 or 39 centre and private providers are 42. Of those 42, some 23 are stand-alone. It shows it does not matter whether it is a private provider, HSE or section 38- or 39-funded. There is one regulatory framework for them all and there is one approach to the regulation of all the nursing homes.
Pádraig Rice (Cork South-Central, Social Democrats)
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There are three members remaining and just 15 minutes left so we will stick to five minutes for the final three slots. The next slot is Fine Gael and Senator Boyle.
Manus Boyle (Fine Gael)
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I thank the witnesses for attending. I will just ask a few direct questions here. What we saw on RTÉ was really dreadful. Everybody in the country has an opinion about a nursing home. It would be the last place they would want to send anybody after what we saw on the television. How are we going to change the culture and behaviour in nursing homes? This seems to be going on a long time. It is coming to the fore now but if it has been going on a long time, it is very hard to get staff to change their culture and their behaviour. What can HIQA do about that?
HIQA has a large duty of care here. I did not know the authority was notified 12 days before the programme. I know in my business if something went wrong and someone reported something, I would be there within the next two hours to try to see what was going on. We need to change the way we think. There are 95 nursing homes under review. Why is it left so late? There should be a basic staffing level in every nursing home so that if there are, say, five patients, the home has to have six or seven staff. I am only new to this but I know from looking after grandparents and listening to my mother and father and so on there is a great lack of staff in nursing homes. It seems to be cut to the bone. Whatever they can get away with to get through the day. HIQA needs to enforce something so that if a nursing home is operating on any given day they need ten staff or whatever. There has to be something because once the rules are put aside even a wee bit then they try to get away with it.
Ms Angela Fitzgerald:
The question about staffing is really important. Having adequate staffing means that people can go beyond doing the tasks and they can do all the caring. When there is not enough staff, people are stretched and we saw some evidence of that. We very much advocate for the staffing framework. Currently, our role says we can comment on what we observe on a site in terms of adequate staffing. Having a staffing framework, as the Senator said, requires that providers in the first instance ensure those minimum staffing numbers are there and then we can regulate that they are doing that. That is coming. The Chief Nursing Officer in the Department is working on that. When it is available it will really strengthen our ability to address what the Senator said.
The Senator is right on culture. As Senator Ryan also pointed out, culture cannot be changed in a day. We know that as an organisation ourselves.
We have talked to a number of providers about what they rely on to tell them all is well from a culture point of view. There are some important statistics. What staff say about working in a place and what they say to their employer which they might not say outside is really rich information. Some more enlightened providers are now doing that. It is something we want them to give us as part of their frame of reference, so we can get that information in addition to the information we receive directly from staff. The Senator is right that it is critical.
My mam had dementia. I minded her for ten years at home. My father-in-law had a stroke and has very limited speech. They are very difficult jobs. They are not easy to do and we as a society have to give recognition to those jobs. A young person with a degree will not look at these jobs when he or she can look at other things. It is about how we remunerate and reward people for these difficult jobs, particularly at the level below nursing. Nursing is a challenging job in any setting. The minimum qualifications and staffing requirements are essential. They are coming and we are happy about that. They will allow us to intervene more objectively and less subjectively in this space.
Culture is at the heart of the human condition. It is how we see the other person. You cannot teach that but you can give leadership and guidance. As leaders in organisations, that is the role of the board of directors, the board of management and the nurse manager on the floor. They need to be on the floor. Some of our systems, collectively, have required people to move away from the floor and they have to get back to that. The Senator has raised really important issues.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Apologies for being late but I was listening in. Ms Fitzgerald made the point that nobody wants to see CCTV, surveillance or monitoring 24-7 in a nursing home. It goes back to the culture, as she alluded to. After seeing that programme, I would not blame people for wanting that for their loved one. Trust will take time to rebuild. The culture will take time to be inculcated in any organisation. If you have an elderly parent or loved one at the moment, you probably do not have much time to see that culture being fostered. I am not advocating for 24-hour CCTV or surveillance in nursing homes, but does HIQA do undercover work, be it in the guise of a nurse or healthcare provider, similar to what RTÉ did? If not, should it?
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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If there was legislative change on that, would HIQA welcome it? Should it be looked at?
Mr. Finbarr Colfer:
If we are going there, the system is in a very bad place. Work needs to be done. We need to work on building trust, as the Deputy said. We in HIQA also need to look at getting under the bonnet a bit better. We need to look at how we gather information on culture. We do a lot of examining of leadership and governance of centres because we know good governance is good care and where there is poor governance, there are more difficulties. One of the areas we need to strengthen is how we measure that culture piece.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I am not trying to appear dismissive of that. I am just saying a person with a loved one in their 70s, 80s or 90s does not have the time to see the big, grand change we all desire.
I will move on because time is tight. It was stated earlier that there are over 10,700 beds owned by 15 private companies or corporate entities. Is that system sustainable? I know from the witnesses' figures that it is not necessarily the private ones that are the offenders. It was said there were 95 with restrictive conditions out of around 500 nursing homes nationwide. That is a fifth of all nursing homes, private and public, with some kind of infraction.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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Does that 20% comprise individual infractions in different nursing homes or are they cumulative? Are there possibly five or ten infractions in one nursing home?
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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That is quite significant. I assume there is a scale of severity.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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I assume they are not all in big trouble but that is still significant. Is the model of 10,000 beds in the hands of 15 large companies sustainable? Is it desirable?
Ms Angela Fitzgerald:
There are a couple of things in what the Deputy said. The reality is we have a predominantly private system of care. That was a policy decision made because private sector can respond more quickly to building, extending and making care available. There are questions to be asked when there is that reliance about what else is needed in the regulatory framework, and we have talked about that. In our experience, and the data here shows this, it is not private versus public. It is about the ownership, management, leadership and commitment of individual providers and teams to delivering care. It is important we do not demonise the private system but it is also important we look at the corporate obligations. We have talked about that.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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A lot of the discourse has been leaning that way up to now but based on what the witnesses have said, that is not necessarily reflective.
There was an incident in the "RTÉ Investigates" programme where there was a lack of incontinence sheets for beds and people were encouraged to defecate in bed. In that situation, who is at fault? Is it the employees for making do? I saw they tied a few incontinence pads together to provide a sheet. Is it management for not providing the equipment? Is the employee just as culpable for making do at 2 a.m. without the resources required to do the job?
Maria McCormack (Sinn Fein)
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I am from Laois and live in Portlaoise. Unfortunately, when I was watching the programme I recognised some of the residents and workers. It is very difficult for them. I have a lot of questions so I will go through them and I request brief answers.
I have to correct the record by noting that The Residence, Portlaoise opened in October or November of 2023, not in 2024. There have been 40 notifications of abuse and 17 reports of serious incident or injury to a resident that resulted in hospital admission or death. There have been four notifications of unexplained absence. That is where a resident was able to get out of the nursing home. I want to hear about these. I am happy to hear the witnesses talking about the footage that was not shown. Living in Portlaoise, I know there was a lot that was not shown. I have families reaching out to me every day. Some families did not give permission because of the severity of the abuse. There is a whole other level of investigation that needs to go on.
The witnesses spoke of culture and of bringing in ways for staffing levels to be notified daily. Do they have plans for this? We know everyone clocks in and out so why is HIQA not notified?
Admissions to The Residence, Portlaoise were paused when all this was going on. I think it was in April. After admissions were restricted or paused, however, it still took in more residents. Ballard Lodge, another nursing home in Portlaoise, closed. We will not go into it but they were able to move from one situation to another situation. Because it is a private nursing home, it is allowed to get away with this. What powers does HIQA need to have a system in place that will work? As far as I can see, the public system is okay to deal with it but if it is private, there are no consequences so they can do what they like.
Mr. Finbarr Colfer:
I will start with that final question. We apply the conditions for admissions. That is a condition we apply when we are in escalation and when we are very close to cancelling the registration. We apply a condition to a centre. The provider must adhere to that and then demonstrate improvement. In that case we applied the condition. The provider continued to admit people. Once we heard that, we went out, met the provider and warned we will prosecute it if it does not-----
Maria McCormack (Sinn Fein)
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That is okay. I want to move on. Of the 17 reports of serious injury that resulted in hospital admission or death, when was the first of them reported?
Ms Susan Cliffe:
I do not have the exact date but we can get that information to the Senator. I can tell members all the notifications we were receiving relating to Portlaoise is what informed our frequent inspection activity. It is what told us that after last inspection, the provider was not implementing the action it was supposed to be implementing. It is why we went out again so quickly.
Maria McCormack (Sinn Fein)
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Was there a death related to abuse in the nursing home?
Pádraig Rice (Cork South-Central, Social Democrats)
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That brings us to the end of all of our speakers. I thank the representatives from HIQA for their time today, for the work that went in advance preparation for the opening statement and for their consideration of all the questions we had today. After today's session members may have additional questions. There was a lot in that session that needs to be teased out. With witnesses' agreement we might invite them back again to tease out some of that, if needs be, in the near future. Thank you very much for your time.
Michael Cahill (Kerry, Fianna Fail)
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Chair, it is important that they are invited back in. I am new. I put in a lot of work preparing for today. I acknowledge everybody else did. I would like to get answers to all the questions I asked. This is a huge issue. There is public anger out there.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you Deputy. We were clear it was five minutes per speaker. If you want to use your five minutes making a statement and leaving no time for answers, that is your prerogative but you do have to allow time for the witnesses to respond to the questions.
Michael Cahill (Kerry, Fianna Fail)
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Five minutes, in the context of such an important issue-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Yes. Absolutely, Deputy. We now have another session with the Minister of State.
Michael Cahill (Kerry, Fianna Fail)
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Will I be able to get written replies?
Pádraig Rice (Cork South-Central, Social Democrats)
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We have another session now with the Minister of State who is waiting. They will follow up in writing.
Michael Cahill (Kerry, Fianna Fail)
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Chair, going forward, when it is such an important issue around the neglect of our elderly - the care of our elderly cannot be emphasised strongly enough - we should be given more time.
Pádraig Rice (Cork South-Central, Social Democrats)
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Absolutely Deputy. Time is tight. We were allowing time for each member to come in individually and each member was given the same amount of time. Everybody was allocated the same amount of time. The session is tight, as we have another session on the same issue now with the Minister of State who is waiting. I want to thank members and witnesses. We are going to take a very short two-minute break as we prepare for the Minister of State to arrive.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will now further consider standards of care and related practices in nursing homes and the oversight of these matters. To continue the committee's considerations of these matters, I welcome Deputy Kieran O'Donnell, the Minister of State with responsibility for older people. I also welcome officials from the Department and with members' agreement, some of the officials may answer some of the questions. Is that agreed? Agreed. I invite the Minister of State to make his opening remarks.
Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the Cathaoirleach. I thank members of the committee for the invitation to speak to you today regarding the crucial issue of standards of care in nursing homes and the oversight of these matters. I am joined today by Ms Siobhán McArdle, assistant secretary in the social care, mental health, drugs policy and unscheduled care division in the Department of Health. I am also joined by Mr. Trevor Moore and Ms Laura Casey,principal officers.
I acknowledge the “RTÉ Investigates” programme that was broadcast on 4 June. I commend them on this very important piece of work. This hard-hitting and harrowing programme highlighted a litany of poor care standards in two nursing homes, showing clear neglect and abuse of older people, namely, The Residence, Portlaoise, and Beneavin Manor, Glasnevin. The welfare of both the residents and their families was obviously at the forefront of my concerns following the RTÉ programme. I am conscious of the impact this programme will have had on the residents, their families, and the staff in the nursing homes featured in the broadcast. I am also conscious of the impact the programme will have had on the nursing home sector more generally. It is important to acknowledge the committed, compassionate, and dedicated providers and care staff operating in nursing homes across the country. Like everyone else watching the programme, I was shocked and deeply concerned at the level of non-compliance with care standards in evidence from the distressing footage that was aired. I welcome that referrals have been made to An Garda Síochána.
In a subsequent "RTÉ Investigates" programme, broadcast on 10 June, we also heard personal testimony from Mr. Paul Guy on behalf of the family of Audeon Guy, regarding the poor ongoing care that their father had been receiving in Beneavin Manor. I know the feelings articulated by Paul struck a chord with everyone who has had a loved one in a nursing home.
As Minister of State with responsibility for older people, I want to state categorically that poor care, mistreatment, neglect, and any other form of abuse of any person living in a long-term residential care centre is completely unacceptable. I expect the highest standards of care to be upheld by providers for every resident in every nursing home across the country and anything less than this standard will simply not be tolerated.
As the national independent regulator of nursing homes in Ireland, I expect HIQA and the office of the chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. Department of Health officials and I met HIQA on 4 of June to discuss regulatory activity relating to the nursing homes featured in the "RTÉ Investigates" programme. At this meeting, HIQA’s chief inspector confirmed its continuous intensive engagements with the two nursing homes in question. On 13 June, HIQA furnished me with an interim report on its engagement with the two nursing homes over the previous two weeks. This interim report details HIQA’s inspections of these nursing homes since the "RTÉ Investigates" programme was broadcast and its ongoing work in this regard. The report also provides a brief overview of the Emeis Ireland group.
With Department of Health officials, the Minister, Deputy Carroll MacNeill, and I met HIQA yesterday, 17 June, to discuss this interim report. I wish to advise the committee that the interim report has been published and also furnished to the committee and is being considered, along with a full report that is due from HIQA by the end of this week. The interim report was published yesterday.
Regarding the full report, I formally requested that HIQA furnish me with a comprehensive overview report of all of the nursing homes in the Emeis Ireland group, including an up to-date position on The Residence, Portlaoise and Beneavin Manor. It is critically important that residents of these nursing homes reside in a caring and safe environment. I am expecting this full report from HIQA by the end of this week, providing a comprehensive overview of the regulatory history, including, but not limited to, regulatory compliance, escalating enforcement actions and any additional conditions of registration.
HIQA has acknowledged in the interim report the importance of examining its processes and methodology. It is essential that these be looked at continually for ways to improve the inspection and regulation of nursing homes.
I assure the members of the committee that I will continue to closely monitor developments regarding both nursing homes. The welfare of residents and their families will remain our highest priority.
Last week, with Department of Health officials, I had constructive engagements with representative bodies and stakeholders from the nursing home sector, with an immediate focus on delivering the highest quality of care to the residents of nursing homes. With the officials, I also met HSE senior staff and management from six health regions last week. This engagement was constructive and centred on supporting residents and staff in community nursing units across the country in delivering the highest quality care.
I want to be clear that every nursing home resident deserves, and should expect, the highest standards of care at all times. To achieve this, it is paramount that registered providers of nursing homes adequately support their staff. Having effective governance and management arrangements in place ensures that staff are equipped to deliver person-centred care to residents.
I wish to advise members of the committee that, with Department of Health officials, I have met the HSE chief social worker and HSE staff and management from the two health regions where the two nursing homes are located. The HSE has confirmed that the directors of nursing from both local HSE community support teams have been on site in both nursing homes and are continuing to engage with them. A review of safeguarding concerns that have been raised about the two nursing homes is ongoing. The HSE has also confirmed that it will be engaging with all nursing homes in the Emeis Ireland group over the coming week.
I will turn now to adult safeguarding. I am fully committed, along with the Minister, to strengthening existing safeguarding protections across the health and social care sector and we will publish the first ever national adult safeguarding policy for the sector shortly. The policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of legislation, policies and procedures already in place in the sector for preventing, reporting and responding to abuse. The Government has included a health (adult safeguarding) Bill in its current legislative programme to facilitate this. It is recognised that this will be an important further development in preventing and protecting vulnerable adults from abuse.
I would also like to advise the committee of work that is ongoing by the Department of Health to develop a framework for safe nurse staffing and skill mix for long-term residential care settings for older people. This work is being overseen by a task force. A research team from UCD and UCC have undertaken substantial research and testing of a methodology for determining safe staffing in the sector. This work is near completion and I expect to receive recommendations on how this can be implemented shortly.
I want to firmly reiterate that poor care, mistreatment or any other form of abuse of any person living in a long-term residential care centre is wholly unacceptable and will not be tolerated. Every resident of a nursing home deserves dignity, respect and the highest standards of care. As Minister of State with responsibility for older people, I am committed to ensuring that everything possible is done so that the distressing scenes we witnessed in the recent "RTÉ Investigates" programme do not happen again in any nursing home across the country. Colleagues, we must work together to create the policies and legislation to further protect our older people. They deserve the best of care. When I was appointed as Minister of State with responsibility for older people, the Taoiseach and the Tánaiste asked me to deliver a better future for our older people. That is what I am determined to do.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank to the Minister of State. We will now move to members by rotation. I ask members to try to stick to the time, as it will be tight and I want to try to get as many members in as possible before we finish at 12 o'clock. The first slot is Fianna Fáil's.
Michael Cahill (Kerry, Fianna Fail)
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I acknowledge the Minister of State's swift engagement with HIQA following the RTÉ broadcast. I welcome the interim report he requested. However, these events have exposed long-standing weaknesses in both oversight and accountability. I have the following five questions.
First, regarding independent oversight, will the Government now commit to independent to commissioning a full and independent audit of HIQA's effectiveness, governance and inspection procedures?
Second, when will the Government introduce adult safeguarding legislation, as recommended by the Law Reform Commission? Will it include mandatory reporting of abuse and the legal recognition of care partners? Will it give safeguarding social workers a legal right of entry to private care facilities?
Third, in regard to systemic flaws, how will the Government respond to the structural issues that continue to allow poor care to persist? We cannot excuse abuse or neglect on the basis of staff shortages or the aftermath of Covid any longer.
Fourth, regarding complaints and accountability, what actions will be taken to create a fit-for-purpose complaints mechanism for social care? HIQA does not handle individual complaints, the Ombudsman will not examine clinical matters and "Your Service Your Say" is limited to the HSE, yet 81% of all people in long term care are in the private sector. How will the Government close this gap?
Question five concerns privatisation and the future of social care. In light of these failures, is it time for a fundamental re-evaluation of how we deliver long term in Ireland? Will the Government consider a moratorium on further privatisation and instead begin building a system that prioritises public provision, transparency and dignity?
Our older citizens deserve care that is safe, dignified and humane. As the Minister of State is well aware, the public is outraged. Their trust in oversight is broken and only truth, accountability and reform will rebuild it. This committee must not shy away from the scale of that task. Today, we need more than explanations. We need commitments, timelines and the political will to deliver a real change. The public is watching.
Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Cahill. To address the points he raised, starting with independent oversight, HIQA representatives just attended at the committee. HIQA is carrying out a review of its processes. It has acknowledged that they need to be reviewed. In terms of further oversight, it is something we are considering in the Department. Along with the Minister, we will make a recommendation to the Government on how we proceed with that.
Regarding adult safeguarding legislation, the Minister is due to bring to the Cabinet an adult safeguarding policy. This is mentioned in the programme for Government. Included in that will be the requirement for legislation. That legislation is already in the legislative programme. I will be looking to expedite that.
Regarding systemic flaws, a couple of things have come out. HIQA has now come back and made a recommendation on the regulation of groups. There are a couple of points. One, we need to regulate the parent. Two, we have to make changes to address nursing homes changing hands in any form. Currently, if a nursing home is a sole trader and is bought by another person, that new person has to re-register. If a nursing home is a limited company and there is just a change in the shareholding, it does not have to re-register. It just has to inform of the change. I want it to be the case that a nursing home that changes hands in any form - by way of purchase as a sole trader or purchase as a limited company - must go to HIQA for re-registration. That should be an absolute.
HIQA has brought that forward on foot of the work it has done now.
The Deputy referred to protecting the future. I have concerns about growth in the groups area. Last January, the Department commissioned a body of work from the European Observatory on Health Systems and Policies to examine the growth in the group structures in Ireland and assess the risks involved if they were to fail and in cases of poor care. The report is due in September and we will give it consideration. Given that we will always have some element of private sector involvement, the critical point is that the standard of regulation is key. Changes need to take place and the Government will work on that.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister of State and welcome the schoolchildren in the Gallery.
David Cullinane (Waterford, Sinn Fein)
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What percentage of all nursing homes is private?
Kieran O'Donnell (Limerick City, Fine Gael)
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Just over 75% of nursing homes are private.
David Cullinane (Waterford, Sinn Fein)
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Over the past ten years, on Fine Gael's watch, the percentage of private nursing homes has gone from 35% to nearly 80%. Of the ten prosecutions that HIQA sought last year in respect of nursing homes, how many were corporate or private nursing homes?
Kieran O'Donnell (Limerick City, Fine Gael)
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I do not have the figure.
David Cullinane (Waterford, Sinn Fein)
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The Minister of State has responsibility for this sector and there has been a scandal in a number of nursing homes. There is a big focus on the lack of regulation, which I will discuss in a moment. I will give the Minister of State the answer to save him sifting through the pages in front of him. Eight out of the ten prosecutions sought last year were related to these corporates.
David Cullinane (Waterford, Sinn Fein)
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On the Government's watch, a lot of family-run nursing homes have been run out of the market and corporate companies have come in, in particular, the company that was the subject of an "RTÉ Investigates" programme. HIQA has said it needs new powers to deal with corporate entities. The Minister of State is on record as saying HIQA does not need any more powers. It does and this is obviously one of the areas.
In respect of First Care Beneavin House Nursing Home, how many allegations have been made of suspected or confirmed instances of abuse of a resident or worker?
Kieran O'Donnell (Limerick City, Fine Gael)
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It is in the report.
David Cullinane (Waterford, Sinn Fein)
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Again, to save the Minister of State the effort of rustling through his papers, it is 198.
Kieran O'Donnell (Limerick City, Fine Gael)
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It is in the report.
David Cullinane (Waterford, Sinn Fein)
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Yes, but the Minister of State should know these figures. There were 198 allegations.
David Cullinane (Waterford, Sinn Fein)
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How much in financial penalties was imposed on the nursing home or nursing home group?
Kieran O'Donnell (Limerick City, Fine Gael)
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I do not know. It is a matter for HIQA.
David Cullinane (Waterford, Sinn Fein)
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No, it is a matter for the Minister of State and the Government. I need to outline this from my perspective. The Government has allowed a situation to arise where we have drifted from a majority of nursing homes being publicly run to a majority of nursing homes being privately run. Even within that, what are called "mom and pop" nursing homes - the family-run nursing homes - have been run out of the market and the corporates have come in and cut costs and are providing substandard care. We saw outlined that one of them had, over a number of years, 198 allegations of suspected or confirmed abuse of a resident.
David Cullinane (Waterford, Sinn Fein)
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No financial penalties were imposed because HIQA does not have the power to do so, as it told us earlier.
Kieran O'Donnell (Limerick City, Fine Gael)
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On fines, HIQA can take any nursing home to the District Court and fines can be imposed by the District Court.
David Cullinane (Waterford, Sinn Fein)
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I know that but zero fines have been imposed on this group.
David Cullinane (Waterford, Sinn Fein)
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With all of those allegations, zero fines have been imposed on this group because HIQA does not have the power to do it. HIQA told us that this is one of the areas it would like reviewed.
Is the Minister of State aware of the Emily case?
David Cullinane (Waterford, Sinn Fein)
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What home was involved? Was it a nursing home? Does he know in what year that occurred?
Kieran O'Donnell (Limerick City, Fine Gael)
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It was a good number of years ago. It was in 2020.
David Cullinane (Waterford, Sinn Fein)
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Is the Minister of State aware of the Leas Cross case? Does he know when it was?
Kieran O'Donnell (Limerick City, Fine Gael)
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It was over 20 years ago.
David Cullinane (Waterford, Sinn Fein)
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Yes. Is he aware of the Brandon case in County Donegal?
David Cullinane (Waterford, Sinn Fein)
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Is he aware of the Grace case most recently?
David Cullinane (Waterford, Sinn Fein)
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After all of the television programmes and the Leas Cross case, which dates back 20 years, the need for adult and safeguarding legislation was called for. The Minister of State came here today and said the Minister will bring a memo on policy. There is no legislation and the same applies to the programme for Government. We do not even have the heads of a Bill, which is not good enough. We do not have safeguarding legislation for adults. We have had a myriad of failures where adults in nursing homes, disability centres and a foster home have been badly let down. There is no mandatory reporting of neglect or abuse. There is no legal right of entry for social care teams. Despite me and others, including experts in this field, calling out the Government for years after every scandal, the Minister of State has come in here today and there is still no safeguarding legislation. Will he give us a date for when that legislation will come before the Dáil?
Kieran O'Donnell (Limerick City, Fine Gael)
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I will first clarify a point. Under the legislation, HIQA can bring nursing homes to the District Court, which can impose fines. It is not fair to say that there is not a mechanism in place because there is.
David Cullinane (Waterford, Sinn Fein)
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No fines have been imposed on this group.
David Cullinane (Waterford, Sinn Fein)
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After all of the abuse and neglect, families will feel let down because there have been no fines - zero.
Kieran O'Donnell (Limerick City, Fine Gael)
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That was a decision by HIQA.
Kieran O'Donnell (Limerick City, Fine Gael)
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If we need to look at fines, we will.
David Cullinane (Waterford, Sinn Fein)
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HIQA does not have the power to issue fines. The Minister of State should listen back to what HIQA said.
Kieran O'Donnell (Limerick City, Fine Gael)
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That is not strictly correct.
On safeguarding, I would like to have seen that come before now. However, in the memo that will go to Government we will look for a decision to bring forward safeguarding legislation as a matter of urgency.
Kieran O'Donnell (Limerick City, Fine Gael)
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That means we will start drafting legislation once there is approval. I am sure the Deputy will appreciate that this is a priority and we must get this legislation through. I have been in this role a relatively short time and I have committed to getting it over the line.
Peter Roche (Galway East, Fine Gael)
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I appreciate that the Minister of State has taken this issue by the scruff of the neck. We are all wiser now and hindsight is wonderful. The "RTÉ Investigates" programme has highlighted something that has now landed on the Minister of State's desk. It has been a most tragic and unfortunate set of events. I will not ask for dates and I do not want to expose anyone in any way, shape or form, except those who need to be exposed, namely, the people who manage the care homes. As I said, we are all wiser in hindsight.
As I watched the recent programme we have all heard about, which I did not watch in full, one of the things that came across was the unsuitability of the people who were in the positions of care. As I mentioned to the representatives of HIQA earlier, sometimes people were employed for the sake of employment. The people employed in hospitals and care homes must have a degree of suitability for the position or post for which they have applied. The people we witnessed in the programme were more suited to working in an abattoir than to caring for the very people we entrust to them to see out their lives.
There are some magnificent nursing homes around the country, private, public and otherwise, and some magnificent care is being administered. Given that this appalling abuse has now been exposed, the Minister of State has the task of ensuring that where people want to work in the healthcare sector, the interviewing process in some way ensures they are suitable and are not taking up the job for the sake of getting an income but because they want to work in the sector. It behoves us and the Minister of State to make sure that where any nursing home or care institution requires staff, the person to be employed fulfils certain criteria before carrying out the duty of seeing people through to the end of their lives.
I wish the Minister of State well with that. It is not an easy task, but at least he is now aware of the issues that need to be tackled head-on.
Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Roche. I will make a couple of points. The safe staffing mix and qualifications for staff are currently being looked at by a task force. We expect to receive that report very shortly. It is something we will act on as a Government.
As stated, safeguarding is an absolute priority. It should not be overlooked that there are safeguarding regulations in place, through the HSE and HIQA, regarding the abuse of people in nursing homes. Notwithstanding that, we must bring in legislation to strengthen the regulations.
I met representatives from HIQA on 4 June. I asked them two direct questions. I did not get a chance to refer to this with Deputy Cullinane due to time limitations. I asked if they had sufficient powers and resources. In both instances, they said yes. I am glad, on the basis of the work they have done in the past two weeks, they have now highlighted other areas that require changes, such as those relating to parents groups and that area of regulation. That is something we want to act on properly.
Another thing I have asked HIQA to do involves taking a practical measure. At the moment, the reports the authority issues are historic in nature. In other words, it only reports on what happened on a particular day. It might report two or three months after an inspection. I want HIQA to report with an updated position in respect of nursing homes. People who are putting loved ones into nursing homes or people going in themselves are entitled to know the up-to-date position in respect of a nursing home. Currently, they do not get that from the HIQA inspection reports. As a result, I have asked it to make that immediate change. Furthermore, in the context of one of the nursing homes, the issue that arose related to new staff coming in. Nursing homes should be required to advise HIQA where there is a change in staff. I have asked HIQA to bring those measures in. It can do so without any need for legislative change.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister of State. The next slot is the Labour Party's. I call Deputy Sherlock.
Marie Sherlock (Dublin Central, Labour)
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I thank the Minister of State and his officials for coming before the committee. In the context of the registration of nursing homes piece, there is so much to be aghast at in this interim report we received last night. How is it that a company can buy a nursing home and effectively piggyback on the good work of the previous owners and not have to register with HIQA? If I wanted to set up a preschool facility in the morning with ten or 15 children, I would have to go through all sorts of hoops with Tusla. How has this Government allowed a situation to arise here companies are able to buy up nursing homes and not register with HIQA on the point of purchase?
Kieran O'Donnell (Limerick City, Fine Gael)
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The Government provides the policy to allow independent regulatory bodies like HIQA to function. HIQA did not formally request that specific measure up until the interim report. What happened historically was that most nursing homes were probably family-owned and operating as small traders. If they sold the business, then it had to be re-registered. A situation then arose in respect of companies whereby if a shareholding was purchased and there was a change in the directors only, the company was required to notify HIQA of the change of directors but re-registration was not required. That is something we have to change.
Marie Sherlock (Dublin Central, Labour)
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It is a policy of facilitating big companies effectively taking over-----
Kieran O'Donnell (Limerick City, Fine Gael)
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I refer to all situations. This is something I want us to we move on. The Minister, Deputy Carroll MacNeill, will be bringing a memo to Government very shortly on all these matters in terms of the changes we can bring in the operation or the registering of nursing homes by HIQA. HIQA has acknowledged, in the report and in its deliberations with the committee today, that changes need to be made. In the context of the groups, that is a change we will be making.
Marie Sherlock (Dublin Central, Labour)
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While nursing homes have to register every three years, my understanding is that they do not have to provide financial information. HIQA is registering nursing homes that are potentially insolvent or that are going to become insolvent in the future, and then the HSE has to step in. How many nursing homes did the HSE take over last year and how many has it taken over this year? What is the Minister of State's view with regard to the lack of a review of the financial situation of nursing homes? Clearly, that is contributing to some of the issues relating to profiteering and to the situation with or negotiations on fair deal in terms of the financial viability of some nursing homes.
Kieran O'Donnell (Limerick City, Fine Gael)
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As the Deputy will be aware, in the context of providing security for nursing homes residents, if a provider fails, the State, through the HSE, steps in so that the home can continue to operate. We took over six nursing homes in the past year. There were Bushfield Care Centre, Fearna Manor Nursing Home and Lucan Lodge Nursing Home and three homes that were operated by Aperee, namely, Aperee Living Ballinasloe, Aperee Living Galway and Aperee Living Camp. When HIQA is carrying out its inspections, I would expect that this would be an area it would cover. I will go back to HIQA on the matter. This is something we must look at in terms of the regulatory process. Politics aside, it is all about the carer of the older person.
Kieran O'Donnell (Limerick City, Fine Gael)
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We really need to take a look at this now. On the morning before its programme went out, RTÉ broadcast details of the nursing homes that would be covered. I immediately sought a meeting with HIQA to get the body of work we are discussing done. It is to come back with a further body of work by the end of this week in respect of the overall Emies group. These are matters I take very seriously. We will proactively, as a matter of priority and urgency, be bringing forward changes.
Marie Sherlock (Dublin Central, Labour)
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Is the Minister of State satisfied with the current inspection regime within HIQA? Does he believe there are enough inspectors? Is he aware of high turnover issues with regard to the number of inspectors HIQA has? A report sitting has been in the Department since 2022. It contains very clear recommendations with regard to-----
Kieran O'Donnell (Limerick City, Fine Gael)
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Will the Deputy repeat that?
Marie Sherlock (Dublin Central, Labour)
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I raised this last week in the Dáil. I refer to the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants on pay and collective bargaining for workers within the sector. There are some very low-paid workers in this sector. What has the Minster of State done to ensure that those recommendations are implemented? The report has been sitting in the Department for three years. To my mind, nothing has been done.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have to watch the time, Deputy. The Minister can make a very brief response.
Kieran O'Donnell (Limerick City, Fine Gael)
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Very briefly, as stated, if HIQA, requires additional resources, it should let us know. It has got additional inspectors. The number now is 43. I am not aware of the issue the Deputy raised in respect of turnover. On the strategic workforce advisory group's report, it is something I have engaged on with the officials. It is also something I am prioritising.
Marie Sherlock (Dublin Central, Labour)
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The Minister of State said he met with the stakeholders. Has he met the trade unions?
Kieran O'Donnell (Limerick City, Fine Gael)
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I am very much open to meeting with the trade unions.
Marie Sherlock (Dublin Central, Labour)
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The Minister of State needs to meet with them.
Pádraig Rice (Cork South-Central, Social Democrats)
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For the next round, we will have to go slightly tighter on time. We will only get to each of the groups once before the meeting closes. The next slot is for Fianna Fáil.
Teresa Costello (Fianna Fail)
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First, I want to ask about the right to entry when HIQA is inspecting nursing homes. Does the Minister of State agree that HIQA should have to notify nursing homes about inspections? HIQA mentioned the right to entry. Is the Minister of State satisfied with HIQA going to nursing homes in the middle of the night as standard? Has the authority discussed with the Minister of State any other nursing homes about which concerns were also raised? What is the Department doing about that? I will share time with my colleagues if this is the last opportunity to speak.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State for attending. This is an extremely serious matter. The public expects answers and accountability. Representatives from HIQA were here this morning. We were delighted to meet them but there were certain things such as, under the existing framework, the idea that there were not enough gloves, incontinence wear, sheets and towels in a nursing home. These are countable items. That is not related to culture. That is something that should, under the current regime, be inspectable. The staffing levels are really important. That conversation going on with the Department of Health and HIQA about staffing levels will be extremely important. Regarding individual complaints, we need to be able to facilitate that. I must reiterate too that there should be the ability for HIQA to directly fine corporates that do not keep to the rules. It should not have to go into the courts. There should be a financial penalty.
This is my final point, because I do not want to hog the time and there are other people who want to speak. On the question of private versus public, I came in here with the preconceived idea that this was only corporate. I have concerns about the increasing congregation of people in nursing homes run by corporates. HIQA did reflect today that a considerable number of public nursing homes are under restriction also. I will leave it at that. The Minister of State might reflect on that.
Kieran O'Donnell (Limerick City, Fine Gael)
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I might take the questions in reverse order if that is okay with Senator Costello. I have covered staffing levels. A task force report is due to come to us without delay.
In terms of individual complaints, measures are to be brought in whereby, in cases leading to death or serious injury, HIQA will be able to carry out investigations. That is something we very much want to expedite.
Fines were not a recommendation in HIQA's report or one it ever made to the Department of Health. However, I am very open to looking at the issue directly.
The programme for Government commits to increasing the number of public nursing home beds. That is something I feel very strongly about. This year, there are 615 new and refurbished nursing home beds. A capacity review is currently under way in the Department of Health on public nursing homes. I want to bring forward a proposal to expedite the roll-out of public nursing home beds. The regulations apply across the board in the exact same way whether the homes are public, private or voluntary.
Going back to Senator Costello's questions, 85% of HIQA's inspections are unannounced. To my knowledge, the inspectors do not have to make nursing homes aware of their arrival. They should have a right of entry. The rest of the inspections are announced.
She asked me if I am aware of any issues with other nursing homes. It was brought to my attention by the officials on Monday that there were notifiable incidents in two nursing homes, one of them involving An Garda Síochána. They are two very serious issues. We have followed up by getting the HSE’s safeguarding team involved. My officials will continue to engage with HIQA on the matter.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have only 15 minutes left so we will have four-minute slots for the final round. I will go back to each of the groups once. If members wish to share the slot, as Fianna Fáil just did, it is open to them to do so.
Pádraig Rice (Cork South-Central, Social Democrats)
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We can only get back to each group once more. We are finishing at 12 noon. We cannot fit everybody in.
Pádraig O'Sullivan (Cork North-Central, Fianna Fail)
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We should have been able to share the time more equitably among ourselves.
Pádraig Rice (Cork South-Central, Social Democrats)
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The next slot is for Sinn Féin.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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With a view to the clock, I will keep my questions to the point. The Minister of State spoke about urgency in expediting a commitment to an adult safeguarding Bill, but he has not given any definitive timeline for it. I put it to him that in the absence of the legislation, serious safeguarding issues are being dismissed as compliance issues, which is not reflective of what is happening in nursing homes.
In terms of the Government's commitment to introduce this Bill at some point in the future, does the Minister of State envisage it containing criminal offences of institutional neglect and reckless engagement of those living in nursing homes? Will the State commit to a conditional enforcement of care standards and transparent ownership when it comes to the use of private beds?
In his opening statement the Minister of State said the HSE has confirmed that there will be engagement with all nursing homes within the Emeis group in the coming weeks. HIQA has confirmed to us that there are 95 nursing homes under some level of restriction, but only 40-odd of them are privately owned. My colleague, Senator Ryan, has a query.
Nicole Ryan (Sinn Fein)
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We have history repeating itself here. The Leas Cross scandal led to HIQA being established. Some 20 years later we are sitting here having the same conversations and HIQA is in place. Has the Department ever withheld or redirected funding in response to repeated failures of governance or quality of care?
Kieran O'Donnell (Limerick City, Fine Gael)
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I will take Senator Ryan's question first. Is she speaking about specific funding to nursing homes?
Nicole Ryan (Sinn Fein)
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I am speaking about any of the nursing homes where issues have ever arisen.
Kieran O'Donnell (Limerick City, Fine Gael)
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HIQA is the independent regulator, and it has a number of tools. One is that it can put a restriction on the number of residents in a home. A second measure is to deregister a nursing home, in which case the funding ceases.
Kieran O'Donnell (Limerick City, Fine Gael)
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Absolutely. I assure Deputy Clarke that I want to bring forward safeguarding legislation as quickly as possible. In the programme for Government we have committed to bringing forward a safeguarding policy. The Government must give approval to proceed with the legislation on safeguarding. I want to bring it forward as quickly as possible, in conjunction with the Minister, Deputy Carroll MacNeill. I will work on that on a cross-party basis.
The Law Reform Commission did a very good body of work. Deputy Clarke referenced some of what it said. We will be considering all aspects that should be included in the safeguarding legislation. However, it is worth noting that issues have been referred by HIQA to An Garda Síochána, along with the owners of nursing homes. Currently, there are tools allowing for matters to be referred to An Garda Síochána.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Could I make a point on that issue? HIQA has said the event is referred to An Garda Síochána but where a staff member is operating with limited supplies because of the management and the directors, it is my firmly held belief that those directors should be held responsible for not supplying an adequate level of incontinence pads or sheets for a service for which the State is paying handsomely.
Kieran O'Donnell (Limerick City, Fine Gael)
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I accept the point. It is unforgivable that there were not adequate supplies in those nursing homes. It was neglect.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Will the Minister make it an offence in legislation?
Kieran O'Donnell (Limerick City, Fine Gael)
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We will consider everything in the round in terms of the safeguarding itself. For me, it is once again about improving at all times the lives of people in nursing homes, and more particularly making them safe.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister of State very much. Next, we turn to Fine Gael.
Colm Burke (Cork North-Central, Fine Gael)
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I thank the Minister of State very much for being available here this morning to deal with these issues. He will be aware that I outlined recently my own involvement in nursing homes going back to 2004. As a result of legal action, the Department of Health ended up having to pay out more than €450 million to 20,000 families.
I am concerned that 40% of the funding currently provided for nursing homes is going to 20% of nursing homes, which are the public nursing homes. That means 60% of the funding is being used to care for 80% of the private patients in private nursing homes. The cost per week for a public nursing home is €1,926 per bed. The cost per week in a private nursing home is €1,250. There is a huge gap.
The issue I want to raise relates to the gap. There is no limitation on the number of nursing homes one group can have. We have a situation in business where in certain areas one cannot acquire a competitor. There are rules and regulations on it. Is it not time to bring in a similar regulation for nursing home management? For instance, would the Department and the HSE be able to deal with the situation if the nursing home group we are talking about, which has approximately 25 nursing homes, decided in the morning to walk away and to close down all 25 nursing homes? I am very concerned about that now because of the issue that has arisen. The standard was appalling, as was the way people were treated. We have a responsibility to look at how we deal with this challenge in the future. It is not beyond the bounds of possibility that this could happen. The Department must be aware of it. Going back to the issue I previously raised, relating to 2004, the Department was aware of it for more than 20 years and took no action. We are now aware of this challenge.
I am asking whether the Department is prepared to look at this and bring in the necessary regulation to restrict the percentage of patients it is going to pay for. This is an extremely important issue.
Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Burke. The point he raised is something the Department is very conscious of, as I am. As I said earlier, the Department of Health commissioned the report with the European Observatory on Health Systems and Policies to specifically look at it last January. It will look at the growth of groups in Ireland delivering nursing homes and the risk that poses in terms of them failing financially and of care. That report is due to come to us in September and these are matters we will consider. What we want here is a model that is safe, sustainable, fair and in particular, is all about the care of the older person. It is something that the Department, I as Minister of State for older people and the Minister, Deputy Carroll MacNeill, are aware of and we are doing a body of work around that area.
Colm Burke (Cork North-Central, Fine Gael)
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There are other issues with regard to private nursing homes as well. For instance, all the private nursing homes are paying commercial rates to local authorities. The public nursing homes are not required to do that. Likewise, they are also paying insurance, which is an additional expense. Yet, there is a gap of €700 per bed per week between what a public nursing home is getting and what a private nursing home is getting but the private nursing home has all of these additional expenses. I reiterate that this issue needs to be reviewed. One of these organisations is going to walk, and we are going to be left-----
Kieran O'Donnell (Limerick City, Fine Gael)
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There are two things on that. The Department of Health and the HSE have a productivity and savings task force that is looking at that particular point around savings related to public nursing home beds. We need a mix. I want to promote and expedite the provision of public nursing home beds but we must have a sustainable model in the private. There are a lot of family-run nursing home, and this is a very important point to put out. The greater majority of nursing homes provide a great level of care and have dedicated staff.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister of State.
Kieran O'Donnell (Limerick City, Fine Gael)
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That is something that is hugely important to state as well.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have two slots left. There is myself for the Social Democrats, and we will get back to another Fianna Fáil speaker if somebody wants to come back in. We might alert Deputy O'Sullivan, if he comes back in.
I want to pick up on something about the model of the nursing homes. Am I right in thinking that in the early 1990s, about 30% were for profit and that has now increased to 80%? In the meantime, small operators and community-based or independent nursing homes have closed. The international research shows that you get poorer outcomes in private nursing homes compared with the not-for-profit and community sector. Is that also the Minister of State's understanding?
Kieran O'Donnell (Limerick City, Fine Gael)
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I would like to see that research the Chair has provided. We have an empirical body of work ongoing with the European Observatory on Health Systems and Policies to specifically look at the growth of groups and what the Chair said about their large increase in delivery of healthcare. That sector is regulated as well, and there are good nursing homes there. As I have come into the role now, I want to do a detailed body of work in looking at the sector, seeing that it is sustainable and the implications with regard to the growth of the groups.
Pádraig Rice (Cork South-Central, Social Democrats)
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So the Minister of State is agnostic as to the better outcomes in the different-----
Kieran O'Donnell (Limerick City, Fine Gael)
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It comes down to individual nursing homes. HIQA is regulating across the sector, whether that is in the public, private or voluntary sectors. It is about that individual nursing home. The Chair might provide that research that he has and I will follow up on that.
Pádraig Rice (Cork South-Central, Social Democrats)
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Absolutely. Moving on to safeguarding, the Minister of State mentioned that the HSE has a safeguarding policy.
Pádraig Rice (Cork South-Central, Social Democrats)
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That does not apply to private nursing homes. Is that correct?
Kieran O'Donnell (Limerick City, Fine Gael)
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On the safeguarding policy, you can refer them. They do not have a legal right of entry but with regard to the regulation for safeguarding, that is there.
Pádraig Rice (Cork South-Central, Social Democrats)
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In practice, we are saying 80% of the nursing homes are private but the policy and the right to entry does not apply.
Kieran O'Donnell (Limerick City, Fine Gael)
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Invariably, nursing homes, in virtually all cases, will allow the HSE to enter. That is something that is there. Once again, we still need the legislation and that is why I want to bring it forward as a matter of urgency.
Pádraig Rice (Cork South-Central, Social Democrats)
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That is, I suppose, where I would move to. I am a new TD but I have worked in the Houses for a number of years. I was involved in adult safeguarding legislation that came through the Seanad in 2017, so eight years ago. It was quite a substantial Private Members' Bill that was published. The Law Reform Commission did work on it. What I would like to hear from the Minister of State and the Department is why this has taken so long. We had substantial cross-party support for that Private Members' Bill in 2017 and widespread agreement that it was needed but eight years later, we are still talking about heads of a Bill and drafting. Why the serious delay?
Kieran O'Donnell (Limerick City, Fine Gael)
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Work has been done with regard to the regulations and the legislation by both HIQA and the Mental Health Commission in terms of safeguarding in nursing homes. You also had the national safeguarding office being set up in the HSE and it has put teams in there. On a practical level, they are there.
For me, it is in the programme for Government, and I can only operate in the role I am in now, which is to look at what it is in the programme for Government. It includes bringing forward a safeguarding policy to Cabinet, which the Minister, Deputy Carroll MacNeill, will do very shortly. That is then up for decision. We will expedite the legislation. I can only work with what is in front of me but I am giving the commitment that this will expedited as quickly as possible.
Pádraig Rice (Cork South-Central, Social Democrats)
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The Minister of State talked earlier about HIQA saying its ultimate sanction is the closing of a nursing home and then the HSE often will take it over. Does the Minister of State think there should be sanctions beyond that, like fines? Are those nursing home providers then unable to set up new nursing homes? Are there any rules or regulations to say they cannot do that? The Minister of State's response might be brief.
Kieran O'Donnell (Limerick City, Fine Gael)
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Once again, the fines issue came up in the committee hearing today, which I heard for the first time. They are available to us. HIQA can go to the District Court and there can be fines, potentially up to €70,000, along with prison sentences. On the measures it has, one is the ultimate, which is to close. It has measures in respect of restrictive conditions to stop the nursing home taking any further admissions. It has done this with the Emeis group in its entirety now. Furthermore, it has compliance notices, which are there as well. On the wider issue the Chair raised, that is something I would like to go back on.
Pádraig Rice (Cork South-Central, Social Democrats)
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We have time for one more slot, and next on our rota is Fianna Fáil, if somebody wants to take the time.
Teresa Costello (Fianna Fail)
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I will come in really quickly. I think the lack of time we had with HIQA and the Minister of State was very disappointing. We had an awful lot more to say. The nursing home was being paid for a service it did not follow through on. Will the Department be seeking reimbursement from the nursing home given that it did not provide the service?
I am also interested in what reports the Department is in receipt of from nursing homes to ensure that the staffing levels are at an acceptable level. It came up on several occasions that these nursing homes were understaffed. If they are understaffed, it is quite obvious they are not providing the sufficient service. I would be interested to see if the Department is in receipt of reports, or will there be an increase in the volume of reports it will receive to ensure service levels stay at an acceptable standard?
Michael Cahill (Kerry, Fianna Fail)
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I thank the Minister of State. The scandal since the "RTÉ Investigates" programme has left many of us shaken. Constituents are coming to us and increasingly asking about home care, even though they know they will not even be able to manage. I want to emphasise that we have great nursing homes. In my own county, I was on the board of management for the St. Joseph's home in Killorglin for years. I have worked closely with the community hospitals in Valentia Island, Cahersiveen, Dingle and Kenmare. Since this scandal broke, has the Minister of State actually met representatives of the company involved? I have raised this a couple of times at this health committee. I think it is important we bring the company in here.
Kieran O'Donnell (Limerick City, Fine Gael)
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Deputy Cahill might bear with me. No, I have not met the Emeis group. It would not be appropriate. HIQA is carrying out inspections and investigations with regard to the group. We need to let it do its work. It is important. I do not want to in any way interfere in that process. There is a body of work ongoing with the Emeis group, and it is something I take very seriously.
Senator Costello made reference to the funding. All the nursing homes in the Emeis group have, at the moment, a restrictive condition in place where they cannot increase their numbers. If people leave those nursing homes, they still cannot - let us say it is a certain figure - keep the figure at that level. If people are leaving, the number just goes down.
The broader funding question is a matter for HIQA. In our overall review of the inspection regime and regulatory regime HIQA operates under, I will consider everything to improve the current process, always with the aim of improving the quality of healthcare and providing a safe environment for older people in nursing homes. That is my primary concern.
Teresa Costello (Fianna Fail)
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If nursing homes are not providing the service and basic needs to residents, they should not be getting paid. They should be refunding money. Some kind of penalty has to be in place, if incontinence pads cannot even be purchased.
Kieran O'Donnell (Limerick City, Fine Gael)
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There is nothing to stop HIQA taking them to the District Court where fines can be imposed, with whatever is required at that court. The wider question of HIQA itself being able to impose fines is something we will look at. We need to bring in an enhanced inspection regime to ensure we have a safe environment for residents and any compliance issues that arise are dealt with immediately. That is why I want the HIQA reporting process to not only include inspection reports going online - people now rely on those - which provide what happened on the day of the inspection, but they also give an update on everything that has happened since.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister of State. We have a two and a half hour slot. We have followed the rota, as agreed. We want to allocate equal time to each group on that rota to ensure that every member can get in and ask questions, but we are limited by the slot provided, which is two and a half hours. It is open to the committee to re-engage with HIQA. As we said to its representatives this morning, we may invite them back for another engagement. Equally, we may engage with the Minister of State again on this issue because I know members have more questions. I hope members will understand that we moved through the rota in the agreed way and provided time adequately and fairly to each group, as was agreed.
Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the committee. I look forward to any further engagement. It is all about a common purpose in very much having safe nursing homes for our elderly. That is the absolute objective. I am determined we get to that. It is something we will continue to work on.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister of State and his officials for their time on this important matter. No doubt we will engage again. The meeting is adjourned until 9.30 a.m. on 19 June, when we will meet with Children's Health Ireland, the HSE and the Department of Health to consider the treatment of children with hip dysplasia, scoliosis and related matters.