Bríd Smith (Dublin South Central, People Before Profit Alliance) | Oireachtas source

I will begin by offering the condolences of People Before Profit Deputies to all who lost loved ones during the pandemic, but particularly those who lost loved ones in care home settings. I thank Sinn Féin for bringing forward the motion, but there should be no deed for it. I refer back to the text of two critically important recommendations People Before Profit secured in the Final Report of the Special Committee on Covid-19 Response. That report was published ten months ago in October 2020. The first recommendation reads:

That a public inquiry be established to investigate and report on all circumstances relating to each individual death from Covid-19 in nursing homes. Draft terms of reference should be presented for consideration by the Joint Committee on Health by the end of 2020.

Many of us in this House worked for hours and hours on the special committee and its key recommendation did not even see the light of day at the Joint Committee on Health. It was a recommendation we in People Before Profit were adamant about including in the committee's report. The public is still clamouring for that inquiry and the demand is being voiced week after week in the national media. We all know that the "Prime Time Investigates" report showed many of the harrowing accounts of those who died from Covid in nursing homes. Calls for public inquiries came from all sorts of parties, many of them very diverse. They included the Coroners Society of Ireland and the Irish Association of Social Workers. As the Joint Committee on Health has not presented the terms of reference within the time frame recommended, I am returning to the demand for a public inquiry from the special committee as a matter of urgency and fully back this motion. Specifically, I am requesting that a report be prepared on the Government's failure to implement this first and most crucial recommendation of the special committee on Covid-19. The timescale for moving to implement this recommendation has gone beyond urgent.

I will also be seeking the report for the Government's failure to implement the second recommendation People Before Profit had listed on the special committee's report.

It states:

A review shall be undertaken into the impact of privatisation on Ireland's nursing home sector and to ascertain its impact on: - nursing levels,

- expertise and qualifications of staff,

- medical and other facilities available in older people's care settings as a result of the policy decisions by previous administrations to incentivise private care settings, resulting in 80% of residential care being provided in the private sector, and

- the adequacy of funding to deliver optimal outcomes.

We sought the review into the impact of privatisation because we refuse to be deflected from the significance of the single most momentous change to have taken place in the care of our vulnerable older people in recent decades. That is the wholesale privatisation of that sector, leaving a position where 80% of the care of vulnerable older people in need of long-term residential care was handed over to the for-profit sector.

In the private nursing home sector that HIQA selected for particular mention in a report last July, it mentioned "very limited clinical oversight of most nursing homes, particularly those in the private sector". I remind Members that private nursing home sectors continue to operate without an acceptable degree of financial transparency. In its report of August 2020, the Covid-19 nursing homes expert panel was clear on the need for greater financial transparency. The State's contribution was over €1 billion via the nursing home support scheme in 2019 and the contribution from the owners of private nursing homes - especially that of larger consortia - remains unknown.

The panel stated that funding and expenditure specifically invested by providers requires greater transparency. This should be noted when there are any changes to the contribution that older people are expected to make, either through their accessible income or assets, to long-term residential care. There must be acknowledgement of how the private sector operates and derives benefits from the scheme. For that reason, we will push for a return to the recommended review into the impact of privatisation on nursing home care.

I will return to an alarming report from HIQA sent to the Special Committee on Covid-19 Response in September 2020. Among other alarming issues, it indicated in the private nursing homes sector an absence of clinical governance, inadequate staffing levels and unavailable contingency plans in the event of sudden and unplanned absences. Resources such as personal protective equipment and access to specialised care and support were lacking and the layout of centres had an effect on the ability to separate healthy and ill residents or isolate ill residents as required. There was also a history of non-compliance with key regulations, such as governance, management of premises and infection control.

The manner in which the pandemic has affected nursing homes obliges us to confront the manner in which we have allowed long-term care of vulnerable older people to evolve in Ireland. There have been very deliberate and highly ideological policy decisions underwriting that evolution. The trauma caused by the Government, its agencies and the nursing home sector should not blind us to the questions we are obliged to pursue relating to the deaths that have occurred in nursing home settings in Ireland.

Some of the stark figures were presented by Sage Advocacy and Age Action Ireland, which demonstrated to us that in July last year, 56% of all Covid-19 deaths took place in nursing homes, a setting where only 0.65% of the population lives. The HIQA report called on nursing homes in Ireland to be investigated but the authority indicated it was not in a position to have a physical presence in nursing homes during the pandemic. The fact remains that most of HIQA's inspectors did not conduct risk inspections in those nursing homes when an increasing number developed Covid-19 outbreaks.

The families of those who lost their lives in these nursing homes must know exactly what happened to loved ones. A lack of communication from nursing homes was a common thread among many of the concerns expressed. There were unanswered phone calls or queries, causing immense anxiety and worry for concerned relatives and friends, particularly in the cases of nursing homes where severe outbreaks were reported. That immense distress and those unanswered questions persist for those who lost relatives and a public inquiry that could provide answers to some of those questions is the very least that the Government owes these families.

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