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

I welcome this long-awaited Bill to progress recommendations 14.4 and 14.6 of the Covid-19 nursing homes expert panel, which the Social Democrats will support. However, it is deeply regrettable that it has taken this long for the Minister to produce the necessary Bill. While these reforms are welcome, the Bill will not deliver fully on the regulatory reform recommendations from the expert panel published almost four years ago.

I appreciate that a consultation process was necessary, but that was completed in 2021. Why did it take another year for the heads of the Bill to be published? The Minister had the support of the Opposition and HIQA, which had called for greater powers for a number of years. When the general scheme of the Bill came before the health committee, we recognised its importance and the need to progress it quickly. That is why, following a briefing by the Department and having considered written submissions, the committee completed its pre-legislative scrutiny in one week. In a letter sent to the Minister, Deputy Donnelly, on 30 November 2022, the committee stated clearly that it considered this to be very important legislation, in light of issues that arose during the pandemic, and it had no recommendations to make.

That was a year and a half ago. What has delayed the Minister of State in progressing the proposal? Where are the blockages? It is very hard to understand why such important legislation has taken so long. We would have to ask whether this was because of lobbyists as it was certainly not because of the Oireachtas or regulator. The expert panel suggested a six-month timeframe for implementation of these reforms. It took the Minister just shy of four years, an incredible delay. This is only the beginning, of course.

The Minister, Deputy Donnelly, and the Minister of State, Deputy Butler, approved a two-stage approach to reform. The first phase, which is being progressed by this Bill, is only an interim solution to enhance governance and oversight of nursing homes. The second phase, we are told, will include a wider root-and-branch review of the regulatory model. It is this second phase that I am particularly interested in. Unfortunately, I do not think the Government shares that interest.

According to the fourth and final progress report on the implementation of the expert panel's recommendations, published in June 2022, an international evidence review of nursing home regulatory models had been commissioned to inform the second phase. When I raised this issue with the Minister of State, Deputy Butler, in November 2022, she said the review was nearing completion and would be published in due course. It is now May 2024, and we still have not seen that report. HIQA sent it to the Department in December 2022, but I do not think the Minister of State ever published it. I would like to think she did so, but I am not aware that she did. I ask her to indicate whether that has been published.

I would also appreciate it if the Minister of State could indicate whether the commission on care is the means by which she is progressing phase two. One would assume so, but we hear very little about this more ambitious phase. Where exactly are we at regarding this? If that is the case, the Minister of State is again way behind schedule, given that she told me, in November 2022 in reply to a parliamentary question, that stakeholder engagement around wider reform would begin in early 2023, which is more than a year ago.

The commission on care only held its first meeting in March. I outline these timelines not to be pedantic in any way, but because of the urgency with which this issue should have been treated and addressed. Overall, we must not forget the context in which these recommendations were made. In September 2020, HIQA appeared before the Oireachtas Special Committee on Covid-19 Response and called for more powers and regulatory reform, a plea that the regulator had been making since 2013.

As the deaths in nursing homes mounted, the need for reform could no longer be denied but it should never have taken this devastating loss of life for the Government to finally act. According to CSO data, between March 2020 and April 2022, almost 30% of Covid deaths occurred in nursing homes. An ESRI study, which examined the first three waves of the pandemic, from March 2020 to March 2021, found that 66% of all Covid deaths during that one-year period were related to nursing home outbreaks. Internationally, this placed Ireland second only to Australia, at 75%, in terms of the percentage of Covid deaths linked to nursing homes. One would imagine that there would have been a sense of urgency about that but a huge amount of time has been lost. This study into the deadliest period of the pandemic also found that larger, long-term residential care homes were three times more likely to have an outbreak than smaller homes.

Those shocking figures should have set off alarm bells in the Department of Health but in reality very little has changed. In public utterances Ministers and even the Taoiseach accepted that we need a new model of care but where is the model to match? Where is that policy we were promised by the current Taoiseach, the previous Taoiseach, Deputy Varadkar, and other Ministers? More and more small, independently-owned nursing homes are closing their doors while large operators, financed by international private equity, dominate the market. That is not acceptable and it is not in the interests of older people. The ESRI found that between February 2020 and December 2022, one in five smaller private nursing homes shut its doors, with rural areas hardest hit. A 2021 value-for-money review of the fair deal scheme rightly pointed out that the more the State becomes dependent on large chains, the less it is able to control costs, terminate contracts, remove residents from poorly performing nursing homes and ensure that standards are maintained. A 2021 HIQA paper, entitled "The Need for Regulatory Reform", also highlighted the risks involved in concentrating care within a small number of large providers. The variety of options along a continuum include supported housing and co-housing communities, of which there is a chronic undersupply. There are lots of other models that could be used for which older people are crying out. The whole spectrum of care needs to be considered, rather than the kind of approach the Government is taking in facilitating people who are more interested in ensuring a return on investment than what is in the best interest of older people. We should be moving towards a situation where long-term residential care is considered only when all other options along the continuum have been exhausted but we are a far cry from that reality. This Government seems, instead, to be focused on cementing the current over-institutionalised model of care by facilitating, even encouraging, its monetisation. All the while, we are told that Government policy is to provide a new model through home care but, again, the facts would say otherwise.

A statutory right to home care has been in development since 2018, after the Sláintecare report recommended ending the "over-reliance on market mechanisms to deliver new health care services by the expansion of public nursing homes and home care". The statutory scheme was supposed to be delivered in 2021. Then it was pushed out to 2023 but now, in 2024, we still do not even have the heads of this long-promised Bill. It is not even listed for priority publication in this Dáil term.

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