Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I am glad to have the opportunity to speak in this important debate. I commend Sinn Féin on the detailed motion it has tabled. Much concern has been expressed about this issue over many years. Clearly, in the past 15 to 18 months, many of the shortcomings in elder care service were brought into tragic and stark relief due to the very high numbers of deaths that took place in our nursing homes. Some of those situations were highlighted in great detail in the recent "RTÉ Investigates" programme. I commend Mr. Barry O'Kelly on the work he did in that programme. There is no question but that the homes covered in that programme, as well as the whistleblowers who came forward and disclosed some of the awful practices that were going on in these nursing homes, require further investigation. There is a need for a public investigation into those particular nursing homes and into the allegations made by those whistleblowers. I have no doubt there are other nursing homes where similar bad practices existed, which resulted in tragedies for a number of the residents concerned.

This is, of course, an issue that we knew about. In many ways, it was a scandal waiting to happen. Was it really any huge surprise that there was such a high death level throughout the period when Covid-19 was raging? It was not really, when one considers how there was such light-touch regulation in this important care sector. That is something for which responsibility must be taken.

People have spoken about lessons that were learned and that need to be learned from the experience of the past 15 months or so with Covid-19. It has been said on umpteen occasions that there can be no going back to the old way of doing things.

There is no doubt that Covid has exposed huge weaknesses in how we provide public services. That applies right across the board, particularly to our health service but also to childcare and to the funding model for our education system. There are specific weaknesses with our provision of social care, whether that is in the context of people with special needs, the area of disability or that of elder care. The pandemic has exposed huge weaknesses in how services are provided, including the over-dependence on the private sector and the farming out of responsibility for what should be core social care services. We must stop that and go back to doing things in a different way. The State must take responsibility for the provision of those services and where they are not being provided directly and there is private involvement, there must be strong regulation.

Prior to last summer, after the first wave, I remember being struck by people talking about lessons that had been learned. I remember very clearly the then Taoiseach and current Tánaiste saying that we must find a new model of elder care. He was very specific about the matter and stated that we could not continue to provide older people's services in the way we were doing. He said that we must be much more creative, much more caring and must listen to what older people and their families want. Despite that, we are 12 months down the road and have seen the third tragic wave and the massive impact it had on older people. That wave took the lives of so many additional older people, caused so many tragedies within families and there is still nothing specific coming from Government about how to ensure that we do not have a repeat of what happened and that we provide services in a more person-centred and responsible manner.

There is no excuse for not learning lessons. This time last year the whole issue of older people's care, and nursing homes in particular, was examined in great detail, first, by the Special Committee on Covid-19 Response and, second, by the expert group on nursing home care established by Government. Their recommendations could not have been clearer. Last year, a very worthwhile submission was made by Sage Advocacy and there were written and oral submissions from that organisation to the special committee. At that time and since, there have been very strong cases made by Care Champions, yet we do not have that new model of care. There are three areas in particular that need urgent attention. The first relates to light-touch regulation, a feature of so many aspects of how we provide things in this country. Light-touch regulation of nursing home care has resulted in large numbers of tragedies and deaths and there is no denying that fact. HIQA, which is supposed to be the regulatory authority in charge of nursing homes, simply does not have the powers it needs to have in order to provide effective regulation. We know that last year HIQA said, "the current regulations need to be modernised and enhanced with additional powers and requirements".

Consider the detail of HIQA's powers. It must give notice of visitations and inspections, it must provide nursing homes with four weeks to respond and many things like that which are just far too weak. HIQA does not have the power to enforce staffing guidelines in the context of, for example, staffing ratios. That is just unbelievable. There are no staff-to-resident ratios in our nursing homes. Why is that the case? As a result of that to which I refer, there are no nurses on duty in many cases and there are large numbers of untrained and unqualified staff providing care and attention to out most vulnerable citizens. Why is that allowed to happen? It is a complete abdication of our responsibility for our most vulnerable people. We also know HIQA has called for safeguarding legislation. It said we must explore suitable structures and processes for external oversight of individual care concerns. Again, how long has this been going on? How long has the matter been with the Law Reform Commission? They were in before the health committee during the year and it does not look like there are going to be recommendations coming any time soon. This is another long-finger exercise.

The special committee made very clear recommendations on increased powers for HIQA, staffing ratios and safeguarding legislation. Those calls have been made and echoed by Sage Advocacy and Care Champions for some time. Care Champions wants HIQA's powers to intervene to be expanded. It wants an end to announced HIQA visits and greater accountability for the nursing home sector. It is asking for statutory staff-resident ratios in all nursing homes. It says we need an independent one-stop complaints mechanism for both private and public nursing homes. Of course, at the root of all this, including the light-touch regulation, is the fact that successive Governments have seen fit to privatise the elder care system. It is essential social care which should be an essential element of our publically-provided health service yet successive Governments have chosen to privatise it to the extent that 80% of nursing homes are private. Nursing home care is now regarded more as a good investment opportunity rather than an essential part of our social care system. Equally, the Irish Association of Social Workers has been very vocal on this. It is essential that social workers have the right to go into all nursing homes and address concerns and complaints that are raised and take those up. However, as of now there is a complete lack of clarity in relation to the role of social workers in safeguarding.

There can be no more excuses for this. All the recommendations and all the weakness are there in black and white from a number of sources. What we need now is action from Government and it cannot come too soon.

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