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

Successive governments have undervalued and under-recognised care and unfortunately, very little has changed in the last three and a half to four years of this Government. It seems that care is increasingly viewed as a commodity, with private providers operating almost 80% of nursing homes, while only 39% of home care hours are provided directly by the State. However, this rampant outsourcing is a more recent phenomenon, particularly in the home care sector. In 2006, funding to private home care providers stood at just €3 million but by 2019, had risen to €176 million. It is welcome that additional funding is going into this sector but why is it all going into the private sector? We know the impact of that. When more money goes into privatising services and outsourcing, we see the monetisation of those services and wealth extraction from them. That is not in the country's interest, nor is it in the interest of those in receipt of care. It is an abdication of responsibility on behalf of the State. This dramatic shift happened with very little co-ordination or consideration from the State, leaving in its wake a largely unregulated sector with poor pay and conditions.

This damaging legacy could be addressed in part through full implementation of the strategic workforce advisory group’s recommendations and the introduction of a long-promised statutory home care scheme, which we are still awaiting. In 2018, a statutory right to home care was first promised, with a 2021 target for delivery. Here we are, almost in 2024, and there is still no scheme. This Government needs to accept that a fundamental reconfiguration of elder care is required. The State’s overreliance on nursing homes, which are overwhelmingly private, cannot continue. We also need to start a serious conversation about the deprivatisation of care and begin investing heavily in our public care infrastructure, as recommended by the Irish Human Rights and Equality Commission in July. During the early days of the pandemic, the Taoiseach and the then-Minister for Health both recognised that the current model was no longer fit for purpose but that seems to have been forgotten. They said very clearly in response to me in the Chamber that the model of care for older people was no longer fit for purpose.

That was in the middle of Covid, and we have essentially seen no improvement on that situation. The arguments for increased reliance on private providers and agencies to achieve cost efficiencies simply do not hold water. We must accept that these efficiencies have costs, which are borne by service users and workers. Any attempt to define care as a product is the very antithesis of person-centred care, a stated ambition of the HSE.

Another area undervalued by this Government, and absent from this motion, is safeguarding. There have been long-standing calls for safeguarding legislation, yet successive governments have dragged their heels, even against the backdrop of a number of the abuse scandals. I appreciate the Government is awaiting the Law Reform Commission’s report, which is expected early next year, but there appears to be very little political will to get this legislation over the line, at least this side of an election. How long have we been waiting for the Law Reform Commission? When its report finally comes, how long will it take to give effect to it in legislation? While the HSE has its own safeguarding policy, a paper produced by Safeguarding Ireland in 2022 found that HSE safeguarding and protection teams were operating in what Safeguarding Ireland called a legal vacuum. Of most concern, private nursing homes are not within the remit of the HSE's safeguarding policy. This means HSE social workers do not have the right to enter private nursing homes. That is a shocking situation and a terrible state of affairs. Some 80% of our nursing homes are privately owned, following a particular policy by this Government and the previous one. The safeguarding aspect of ensuring older people are protected from abuse cannot be implemented within those private nursing homes and HSE social workers cannot gain access for that purpose. That is a shocking state of affairs. We know from the Irish Association of Social Workers that social workers have even received letters from nursing homes informing them they will be prosecuted if they try to enter the premises. Why has nothing has been done about that?

This unacceptable lack of oversight also means that safeguarding complaints relating to private nursing homes are not collected, so we have no idea about the extent of complaints related to safeguarding in private nursing homes. This means we do not have robust data on abuse of older and disabled people. What is not measured does not get any attention. That needs to be dealt with. While I accept HIQA can investigate private nursing homes, its inspections mostly focus on facilities, not individual cases. This absence of investigative powers in cases of abuse and neglect cannot be tolerated any longer. A country with such a long and dark history of institutionalisation and abuse should know far better than that.

The Government also needs to be reminded that the option to live independently in the community is a human right. More needs to be done to guarantee that right. In 2011, Time to Move On: A Strategy for Community Inclusion was published. This document proposed a seven-year timeframe for moving all residents of congregated settings into the community. Twelve years on, there are still 2,300 disabled people living in congregated settings and 1,300 people under the age of 65 living in nursing homes. How can someone with a disability have autonomy if their routine is dictated by a nursing home? It is difficult to have independence when you have a set bedtime and set mealtimes. This was highlighted by the Ombudsman two years ago in his report, Wasted Lives. He found there was a bias towards institutionalisation and a lack of funding to support individuals and their rights.

Instead of addressing these pressing issues, the Government is spending €1.5 million on advertising campaigns about disability rights, all the while continuing to deny those very rights. Under this Government, the experience of people with disabilities continues to be one of social exclusion. They have among the highest poverty rates of any group in Ireland, three times that of the general population, and more than two in five people with disabilities are experiencing deprivation at any one time. The reality for many people is threadbare services and unmet needs. The least this Government could do is ratify the optional protocol to the UNCRPD.

For children with disabilities, the situation is just as bleak. More than 16,500 children are currently waiting for their first appointment with a children’s disability network team. Of these, approximately 10,000 children with disabilities have been waiting for more than a year with no intervention or therapy. I have no idea how the Government can defend that situation. We have 10,000 children with a disability who have been waiting more than a year with no intervention whatsoever. Rather than enjoy basic rights, these children are being actively harmed due to the persistent neglect by this State. Until we start addressing these systemic failures in our social care services, rights-based care will remain purely notional and far removed from the experience of those receiving care.

Earlier today, we heard the testimony of three family carers at an event organised by Family Carers Ireland. It would bring tears to your eyes. That we deny our citizens with disabilities the most basic fundamental human rights brings shame on the State. The Government needs to take action urgently.

See this speech in context