David Cullinane (Waterford, Sinn Fein) | Oireachtas source

We support reform of HIQA’s enforcement powers. HIQA’s current enforcement powers are blunt and we have been saying that for some time. We will support the Bill but the Government has been far too limited in its approach. I met HIQA officials on a number of occasions in recent years on many of these matters. The Bill provides for compliance notices for the Chief Inspector of Social Services at the authority. This is something I called for in a policy document I launched two and a half years ago. It provides for compliance notices to be issued to designated centres for older persons and people with disabilities and improvements to the enforcement system. The Bill also provides for improved data collection on nursing homes and to widen the definition of those eligible to be considered as a family successor to a family farm or productive business assets under the nursing home support scheme, which again we support.

HIQA published comprehensive proposals on improving its governing legislation and enforcement powers in 2013 and more recently in 2017 and 2021. The authority has been calling for these for a long time and it has taken far too long for the Government to act on them. HIQA has flagged that existing definitions fall short of legal clarity and that there are no specific clinical governance links, which resulted in confusion, resistance and adverse outcomes during the Covid-19 pandemic. None of this is addressed in the Bill. HIQA sought improved compliance notices but it also sought a more flexible enforcement system, which included failure to comply with notices and the ability to more robustly attach, enforce and direct implementation of conditions attached to operating licences. The ability to initiate and conduct investigations must also be addressed. Whether this legislation meets the authority's needs will need to be examined further ahead of Committee Stage. It has also called for a comprehensive social care policy and comprehensive social care services regulation. The Government continues to regulate home care, long-term residential care and other types of care separately. HIQA is clearly of the view that supported and-or assisted living and sheltered housing, personal assistance, day services, home sharing, hospice and living services are not covered adequately and should be included in a comprehensive regulatory framework along with nursing homes and home care.

I will make a number of points on the review of the regulatory framework and adult safeguarding legislation. The Government has not progressed an adult safeguarding Act, despite a comprehensive Bill presented by former Senator Colette Kelleher in the previous Seanad, which was reintroduced by Senator Frances Black. Safeguarding teams are a HSE function but they are managed differently across community healthcare organisation, CHO, areas, are often under resourced and do not have access or right to access private facilities. They must be invited by homes, which otherwise investigate themselves. This is unacceptable and has been for too long. Safeguarding teams and social workers need a legal right of entry. Again, this is something we proposed in our policy document some years ago.

We fully support adult safeguarding legislation. The Government’s term has been a missed opportunity because it has not progressed such legislation. Not only do we need safeguarding legislation but we also need a safeguarding authority. Furthermore, we need to look at safeguarding beyond health and through a much wider lens across a range of areas to protect our most vulnerable people. People at risk of neglect, coercion and abuse deserve a comprehensive legal framework for safeguarding in place to protect adults at risk of neglect, abuse, isolation or coercion. There are much broader safeguarding risks in society outside of healthcare settings that it could also address but the Government has ignored this whole area of vulnerable adults. The Covid committee, on which I sat, made a very important recommendation for a full review of the regulatory framework. The Law Reform Commission undertook similar work starting in 2020, which was published last month. I read their proposals last night. They have also published draft Bills in this area as well. This should have been undertaken much earlier as this has been an issue for the past decade. The Minister must expedite adult safeguarding legislation. There can be no excuses. We have to move in the area. Unfortunately it has been one of many areas in which the Minister and the Government have dragged their feet and not delivered.

The Bill provides for a legal right of entry where the chief inspector believes an unregistered centre is operating, but it does not provide a legal right of entry for social workers, safeguarding teams, or family or care partners. If it does, I would ask the Minister of State to point to where that is the case.

On care partners, during the pandemic, families were sounding the alarm of neglect and isolation but were not listened to by the Government. I met many of them over the past year and a half. By contrast, in the North, a care partner scheme was provided for, which ensured two family members could assist in the care and supervision of care of their loved one. The Government in the South has refused to entertain any such scheme, despite its success in the North, which is recognised by families and the Executive and was called for by bereaved families in the South.

The area of home care is possibly one of the Government’s biggest failures. There are currently no quality standards for the provision of home care. Current standards are not enforceable. The Government has not progressed legislation to regulate home care or provide a statutory home care scheme. It has started a pilot project that falls far short of what was committed to in the programme for Government. It took the Government several years to set up the commission on care. Many people who are experts in this area are very concerned about the model of the commission of care which the Minister of State has established.

With regard to the privatisation and consolidation of ownership in the nursing home sector, 80% of nursing home beds are now private; 38% of beds are operated by just 15 operators, of which 14 are funded by private equity firms. All of this has happened under the watch of successive Fianna Fáil and Fine Gael Governments, which have made this an unfortunate reality. Private nursing homes are independent and self-governing. This has continually been identified as a clinical governance concern but ignored by the Minister of State and her Government. The Government has failed to invest in public nursing home capacity and reverse this trend, and where it has opened nursing homes beds, these are being poached in some areas for step-down beds for hospitals, such as in Nenagh. Many nursing home beds across the State are now operating as step-down beds to support hospitals. There may be logic to that but it is all due to the Government’s lack of funding for these step-down beds in the first place.

HIQA has no legal powers to investigate individual complaints. The way the regulation is designed is that the authority looks at totality of the service. The provider has to do investigation themselves and provide findings to the HIQA. The authority has advocated change in this area. If not HIQA, which is a systems regulator, adult safeguarding teams should be responsible and resourced to investigate individual complaints in public and private nursing homes. Private nursing homes should not be investigating themselves.

I have long called for a comprehensive social care policy. The Department of Health should be called the Department of health and social care because social care has been left behind by successive Governments. The Department of Health does not have a comprehensive, integrated social care policy that considers social care in its totality alongside Sláintecare.

Disability services are inadequately regulated, as we have seen from HIQA's proposals. Decongregation has taken a back seat under the Government, which has not substantially progressed decongregation of intellectual disability services.

There are many elements of the Bill I support. Any advance is an advance but when considering all the lessons that should have been learned from Covid, all the reports that have been done by HIQA and all the expert reports from working groups established by the Government, we all know much more needs to be done to put in place proper regulatory systems, proper adult safeguarding legislation, proper enforcement bodies, an independent safeguarding authority and much more to make sure the most vulnerable citizens of our State are protected, and these are areas the Government has completely failed in.

With regard to nursing homes, unfortunately the Minister of State has presided over a system where more and more private capacity is coming in. Very little public capacity has come from this Government. It has been something the Government has ignored and it has allowed the private sector to dominate the nursing home sector. It promised us a commission on care. It took far too long for it to be set up and it will probably be the next Government that will have to look at the implications of that. Were I in the Minister of State’s position, I would change the terms of reference for the commission, as has been advocated by Sage Advocacy and many more groups. I met them today on this issue. The Government’s statutory home care scheme was much promised and a big part of the programme for Government. I suspect it took a back seat because the political will was not there to deal with it and because the resources were just not going to be committed to it.

That is the legacy of this Government.

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