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

I am glad to hear that because we have been waiting for a very long time.

While home care hours and funding have been increased since 2020, waiting lists remain stubbornly high. In February, there were over 5,500 people approved for a home care package but no carer was available. These staffing challenges have only been made worse by the regressive HSE recruitment freeze. That freeze is holding up so much delivery in terms of major healthcare. February's progress report on the implementation of the report of the strategic workforce advisory group showed that three of the 16 recommendations are on hold due to the recruitment freeze. This includes recommendation 11, that there be "a significant increase in the proportion of home support hours and packages provided directly by the HSE". This is just another example of this Government's short-sighted thinking leading to rampant outsourcing. The Minister has been promising the aforementioned significant increase for a very long time and it is really shocking that we have not seen movement in relation to that. Promises are being made but there does not seem to be any timescale in terms of what needs to be done in the best interests of older people.

Privatisation is now the cornerstone of this Government's elder care policy but it was not always this way. In 2006, funding to private home care providers stood at just €3 million. By 2019, the figure had risen to €107 million, while in the nursing home sector over the past 30 years, we have gone from a predominantly State-led service to one where approximately 80% of nursing homes are private. Undoubtedly, tax incentives in the early 2000s and the introduction of the fair deal scheme, which increased financial security for the sector, attracted more and more operators into the sector, especially from outside Ireland. This model, whereby the State is so heavily reliant on private nursing homes, is deeply flawed. In fact, it has become untenable. The pandemic has exposed severely lacking clinical oversight of these facilities and significant gaps in communication channels with the HSE. In May 2020, the then CEO of HIQA, Mr. Phelim Quinn, appeared before the Oireachtas Special Committee on Covid-19 Response. During the hearing he said that "the HSE did not know this sector" and that "private residential care for older persons has no formal clinical governance links with the HSE". That is a damning assessment of what the HSE was doing in respect of older people. As a result, there was no national clinical oversight of the care being delivered to some of our most vulnerable citizens during the spread of a deadly virus that was ravaging the places that so many of those vulnerable people called home.

It is unforgivable that the Government has taken so long to bring forward these interim measures.

Section 10 provides for mandatory reporting of key operational data to the chief inspector by registered providers, as recommended by the expert panel. Section 11 provides for the sharing of this data with the Minister and public bodies, including HIQA and the HSE. The publication of the data will be in aggregate form. In the course of the health committee's meeting with Department officials during pre-legislative scrutiny, many of us were shocked to learn of the complete absence of data collection. There is no national database of even the most basic information, such as staffing levels, bed occupancy or dependency levels. This type of data is extremely important in terms of regulatory oversight, service planning, demand projection and ensuring prospective residents and their families have enough information when choosing a nursing home. That certainly is not the case at the moment. It is bizarre that this is only now being provided for in legislation. There can be no excuse for the delay in progressing this most rudimentary measure.

Section 13, which provides a clear legal basis for the chief inspector to enter a premises that is not registered, is welcome. During pre-legislative scrutiny, Department officials confirmed this does not come up much in the nursing home sector but was brought up by HIQA in the context of disability centres, especially in respect of emergency placements. An explicit provision is needed for the avoidance of doubt should such a situation arise.

In terms of enforcement, the options available to the chief inspector have been repeatedly characterised as blunt instruments. Currently, the chief inspector can either place restrictive conditions on a centre, such as limiting the number of admissions, or cancel its registration, meaning it would have to cease operations or be taken over by an alternative service provider. This does not allow for positive action to be taken to rectify the situation. Prosecution should be the last resort. That is why the chief inspector has called for a more graduated suite of powers. Section 16 provides for that through the introduction of a new system of compliance notices. This will provide the chief inspector with a more efficient and proportionate set of tools to bring registered providers into compliance.

Another issue is HIQA's inability to investigate individual complaints. I accept that the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 gives the chief inspector new powers to investigate serious incidents. However, that legislation has not even been commenced a year after it was signed into law. I received a reply to a parliamentary question today on this matter. All the Minister could say was that he intends to commence the Act at the earliest possible date.

Clearly, there is still much to be done. I do not doubt the Minister of State's intentions but there are serious questions over her delivery on these matters. This Bill is low-hanging fruit but the Government still managed to drag it out over most of its term. Older people deserve so much better than this. They deserve choice and a system that views care as a right, not a commodity. Much more needs to be done.

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