Thomas Pringle (Donegal, Independent) | Oireachtas source

I am grateful for the opportunity to speak on the Bill.

Although I completely disagree with the overall model of care for nursing homes and residential homes for people with disabilities in Ireland, I recognise that this legislation is important in the context of the current model that we have in place.

The recent significant increase in the number of nursing homes in private ownership is a worrying trend. We are seeing more private beds and fewer publicly funded ones every year. In addition, there has been a move to much larger providers, with many provider groups taking over the operation of nursing homes. These providers are mainly financed by international private equity and they run nursing homes for profit. This brings with it many issues. I strongly disagree with the provision of any sort of care for profit. The State should be obliged to provide care for those who need it. We should not allow international private companies to come here and profit from providing what is a necessary care service.

These providers are also given public money through the nursing home support scheme. If we are to put money into anything, it should be public beds and a publicly funded model. All nursing homes and residential homes for people with a disability should be funded and provided for by the State, not for profit. As a recent value-of-money review of the nursing home support scheme stated: "As governments become more dependent on large nursing home chains for services, they are less able to terminate contracts, remove residents from poorly performing nursing homes, ensure that standards are maintained, and control the costs of care." It makes one wonder what the point of government is at all if it cannot manage any of those things.

It has been made clear that we need to move away from this dependency on large nursing home chains and ensure the direct, public provision of nursing home care. The Minister of State, Deputy Butler, should, as a matter of urgency, prioritise this and the recent increase in the number of smaller nursing homes closing. Such nursing homes have a greater connection with the communities they serve. They feel for the people they care for who are not viewed as profit centres or sources of cash. That should be the priority.

HIQA’s Overview Report: Monitoring and Regulation of Older Persons Services in 2022 has shown that while the closures have occurred across the country, rural areas have been most impacted. That is because profit is harder to make in rural areas. You cannot make money out of people, which is what this is all about. The whole system seems to be about making money. Data on closures show the disproportionate impact closures are having on some counties, especially in the west. The report shows that in Donegal alone, there was a decrease of 43 beds in 2022. When nursing homes in communities close, there is a significant impact on the residents who live in the centre, their loved ones and those who are in the process of making the decision to move to a long-term care facility.

The report also showed that private providers owned and operated 77% of designated centres in Ireland, accounting for 81% of nursing home beds. The HSE only owned 20% of nursing homes and 16% of beds. This needs to be addressed, preferably by providing fully funded HSE-owned nursing homes. At the very least, we must ensure that more than half of the designated centres in Ireland are HSE-owned and we no longer depend so much on large international providers.

As I said, I fully disagree with the current model. However, I broadly support this legislation in the current context. What the Bill does not address, and what we need to provide, is intermediate care. Most of the patients in nursing homes should not be in those homes. They are too well to be in them but because there is nowhere else for them to go, that is where they are put. We should have sheltered accommodation in rural areas. There is an example of sheltered housing for rural areas in Ardara in Donegal. That is the kind of model we should be using and encouraging but there are huge difficulties with trying to get somebody to listen and look at what needs to be done. That is a real problem. We could do an awful lot to improve people's lives by making sheltered care available around the whole country.

Section 13 is particularly important as it seeks to provide a clear legal basis for the chief inspector to enter and inspect a premises which is not registered with HIQA. The fact that this is not explicitly provided for in current legislation is concerning. Inspectors should be able to enter and inspect premises where they have reasonable grounds to believe that the business of a designated centre is being carried out there and the premises is not registered with HIQA.

The Bill also provides that the chief inspector will have the power to issue a compliance notice that would set out the action the provider needs to take to bring it back into compliance and a date for the provider to achieve this. Following this, it would be an offence for the provider not to comply with a compliance notice. This is a positive and important step, especially given that there have been examples of compliance issues in nursing homes and residential homes for people with disabilities in the past. For example, the handling of the Brandon report has shown us the importance of raising issues and, unfortunately, the extent that certain people within the HSE, at all levels, locally, regionally and nationally, are willing to go to shut down and cover up some issues. HIQA also has a responsibility in relation to the handling of the Brandon report because it was aware of issues, did not do anything about them and did not raise those issues. That calls into question the idea of HIQA being the so-called independent model that will look after everything and how we can have faith in that organisation as well. That is very important because whatever system we put in place, it has to be accountable and transparent. Every citizen in this country should be able to look at it to see if and what is working and what it is doing. That is the only way that people can be protected and know the system is working on their behalf, not on behalf of the for-profit models.

When will the review commissioned by the Minister of State, Deputy Rabbitte, into the Brandon case be published given that it was due to be published last year? What has happened in relation to it? The Minister of State, Deputy Butler, is not responsible for that but I want to put that question on the record because it is important. It goes to the overall compliance with HIQA and what HIQA will do in the future based on this legislation.

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