David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I commend Deputy Colm Burke on introducing this Bill. Speaking as the author of three Bills that were subjected to the dreadful amendment that they would "be deemed to be read a second time this day twelve months", that was not some form of legislative purgatory as most if not all of those Bills withered on the vine. I hope this Bill will not be one of those, but I would not hold my breath. We will see what happens.

I welcome this timely Bill. Regulation of professional home care is needed, particularly as our population ages and we look to a new model of care for older people.

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The Covid pandemic has shown us the need for a new statutory national framework and strategy for the care of older people. It is a statement of the obvious that we should seek to care for as many people as possible in their own homes. There are cases where that is not possible and people have to go into residential care facilities, including community nursing homes. Some people will also need a period of hospitalisation. However, there are many people in residential care homes who could be in their own homes if better supports were available to them.

The Minister of State noted in her speech that the winter plan announced today includes provision for more home help hours. That provision is quite substantial but it needs to be considered in the context of the substantial cuts that were made in this area over the past five years and more. Those cuts did not make sense when we all agree that we should, as best we can, be treating people in the home. We need to look at the whole area of care for the elderly, including what is happening in nursing homes. I will address that aspect of the matter presently. As a member of the new Oireachtas health committee, which is due to meet for the first time next week, I will do all I can to ensure we deliver a new model of care for older people, and all that needs to flow from that, as part of a broad, in-depth examination of all of these issues by the committee. I look forward to working with the Minister of State, Deputy Butler, and the Minister, Deputy Stephen Donnelly, in that regard.

We need to look at the structural relationship between the Department of Health, the HSE, nursing homes and care providers, the framework for clinical governance and the need for a deep examination of the current provision and the introduction of better legislation and regulations relating to this sector. Changes in the provision of home care must be brought forward urgently in the spirit of this Bill. The Bill is important for a number of reasons, primarily to ensure quality of care but also in respect of the safeguarding of vulnerable adults. While I support the Bill, I would make the point that we cannot look at this issue in isolation from the need to reform legislation in regard to adult safeguarding. I met representatives of HIQA some weeks ago to discuss this issue. We all know what happened in nursing homes as a consequence of the Covid crisis. However, it is true that over time, the vast majority of people get the very best of care in nursing homes. Having said that, there are instances where abuse and neglect occur. Those issues need to be dealt with and there must be investigations and examinations into all such instances.

In private nursing homes, social care teams do not have the power to go in of their own volition; they must be invited to do so. It is a cause for concern that adult safeguarding legislation is quite weak and it needs to be amended. HIQA sets the standards in this area, as it does in other areas and it is very eager to play a role in this regard. Indeed, it has said that there is a need for change in this area. Adult safeguarding concerns also apply in the case of home care, where caregivers are going into people's homes to look after them. We must protect the recipients of that care by ensuring there are proper regulations and enforcement in place. Standards of care are one part of the issue and what this Bill seeks to address. Work in that area is needed but it must be done in tandem with work on adult safeguarding standards, which also requires robust enforcement of legislation. There is an absence of legislation in both areas.

I commend Deputy Colm Burke on the Bill. As I said, I look forward to working with the Minister of State and the Minister, at the health committee, in looking at all of these areas. I genuinely hope we can all work in a spirit of co-operation with a view to ensuring we get the very best national strategy for the care of older people, including in their own homes but also in residential care settings and elsewhere. We need a strategy that is robust and effective and underpinned by strong regulation and enforcement. Where there are breaches, as we have seen in the past, the powers of enforcement must be sufficient to deal with them. Our objective should be to have the very highest standards of care for older people set out in legislation and in a national statutory framework.

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