Matt Shanahan (Waterford, Independent) | Oireachtas source

In the main, no one doubts the Minister of State's bona fides in regard to the work she is doing here. I welcome the arrival of this Bill. The preamble of the Bill refers to its purpose in regard to two existing legislative measures. It amends the Health Act 2007 to give new enforcement powers to the Chief Inspector of Social Services in HIQA, which consequently will provide for greater safeguards of residents of residential care centres. That is obviously to be welcomed.

In addition, the proposed collection, sharing and publication of data is very important from the point of view of residents and their care plans. It is also intended to widen the definition of those eligible to be considered as the family successor to a family farm or productive business assets. That is something that has been highlighted in the fair deal scheme for some time. In the main, that is all good work and not to be faulted.

It is interesting that the background of the Bill suggests that it was the Covid-19 nursing homes panel that recommended the regulatory frameworks should be adjusted and that they needed modernising, and it called for the additional enhancement of the powers of the regulator. Many nursing homes did quite badly during Covid and some in the sector are still struggling to deal with the losses they suffered at that time, in particular private nursing homes. I note that the Bill will also give increased enforcement powers to the HIQA inspectorate to visit non-registered nursing homes. Again, nobody could argue with any of that.

Other speakers referred to the length of time it has taken the legislation to come before the House. As we all know, it is not easy to get legislation passed and through the Houses. Given that the Bill relates to the care of the elderly and disabled people, we should not delay it.

I welcome the Bill but I question whether it recognises the disparity between the private and public sector in terms of residential care settings. The Minister of State is no stranger to the issues of concern to the private nursing home sector. She is well aware in our city of Waterford of two high profile nursing homes that closed in the past two years, simply because of where the costs are going in the business. The operators state that the State is not providing enough funding to cover their costs. There is a very significant disparity between what a public nursing home is paid in capitation and what a private nursing home is paid. I am not sure why that is the case when the preponderance of beds is provided by the private sector. It seems to me that Government policy has created a rush to consolidation whereby large providers are able to make arrangements with the Department on the money they can get, unlike the small guys who cannot.

Another issue we have seen before that affects small nursing home operators is that it is unlikely that they can pay the remuneration offered in public nursing homes, ergo, when they change their staff they are then poached by the HSE. We saw that happen throughout Covid when it was a significant problem. One of the points we must recognise within all of the regulation, which of itself is not always a good thing, is that we need to have standards and compliance with them but the private nursing home sector calls for greater supports in addition to increased regulatory oversight. It will put up with unannounced inspections and all the rest of it but it asks for greater support and understanding of the challenges it faces. The Minister of State knows from our own constituency that there are small nursing homes in rural areas that provide a very beneficial service to their catchment area. It is great that the HSE can come in and say where nursing homes are not compliant and that it needs them to take on a few more staff or do X amount of capital works or whatever else. Everybody feels good when that happens. Staff have gone in and told those guys to tidy up and get going but what we find is that they cannot do it or they choose not to do it because of the costs involved and then we lose those beds. St. Brigid's in Carrick-on-Suir is a case in point. People who were previously able to visit relatives as they were very close are no longer able to do that and they have ended up having to do a circuitous round trip that could be ten or 20 miles. In Kerry, the distances involved could be 30 miles or 40 miles, or perhaps more depending on where a bed becomes available.

In the round, anybody would obviously support the positive developments in the Bill but we have still not addressed issues in the residential nursing home setting, and probably in the disability setting as well, namely, the difficulties involved for those who provide a private service. At times, there is a culture within the public system to label every private for-profit operation as being somehow malevolent and that it is only about profit and nothing else. The Minister of State and I both know private nursing homes where that could not be further from the truth. They have an excellent standard of care. They have directors of nursing and nurse managers who go above and beyond the call of duty to make sure that residents are properly looked after. They do not skimp but at the same time they are not getting the same amount of support from the State. That is a fact. It is not just the private nursing homes saying it. It is a question of why that disparity exists and why we are not trying to address it. I have not read all of the briefing documents but I am not sure it is included in this Bill. That is something we must address in the future because we cannot have a private sector providing 80% of the beds that we do not support, but we support the 20% of beds in the public sector to the hilt. I question why we are surprised at times when we lose private beds.

I will support the legislation as there is good work in it but we must do more. We must stop vilifying the private sector. I hear from time to time in this House when private residential care is being discussed the references to the "monopoly" and the private aspect of it and it is said that it is all for profit. If there is not a profit there, the business cannot operate. Therefore, the residents cannot be cared for in that setting unless the State is going to step in. We do not want it to do that because it often costs twice or three times as much – that is a fact of life – and if that was not the case, the State would have taken over the sector years ago. There is a place for both parties. We need regulation and enforcement but we must also recognise that greater support is needed for the private nursing home sector. That is what I am calling for.

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