Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank Members for their contributions to the debate on the Bill. I look forward to their support as the Bill is considered further on Committee Stage. I note 95% of all those who spoke, even though they raised issues, were supportive of the legislation and I thank them all for that.

The Bill provides for a number of pertinent and timely amendments to the Health Act 2007 and the Nursing Home Support Scheme Act 2009. First, the amendments to the Health Act will bolster the existing regulatory framework for residential care centres regulated under the Act, updating the chief inspector's current powers and amending current provisions to ensure they provide the optimal safeguards for the people living in these centres. The Department of Health has worked closely with the chief inspector in developing these provisions to ensure they are effective and operationally valid. As Minister of State with responsibility for mental health and older people, I would add that these new provisions address several key recommendations in the Covid-19 nursing homes expert panel report, which called for the enhancement and modernisation of powers and requirements within the regulatory framework governing nursing homes and the establishment of mandatory reporting to HIQA of key operational data by nursing homes to support service planning and policy development. Second, through amendments to the Nursing Home Support Scheme Act 2009, the fair deal, it will widen the definition of those eligible to be considered as a family successor to a family farm or productive business assets.

While overall there is good adherence to the regulations across our care services, in a minority of cases compliance is poor, with a direct impact on the standard of care on residents. In these cases, it is absolutely necessary that effective enforcement mechanisms are in place to address these gaps. The specific enforcement measures include compliance notices and the power for the chief inspector to enter and inspect premises where she suspects the business of a designated centre is being carried on while unregistered. Additional enforcement measures include the reduction in timelines for service providers to make representations and lodge an appeal of a decision of the chief inspector to the District Court, with regard to a registration of a designated centre. Cumulatively, these measures will provide for more timely and proportionate interventions where there is a breach of the regulations, thereby providing the chief inspector with further mechanisms to ensure that the current protections for residents, as required under regulations, are adhered to and upheld.

The systematic collection of key data across the sector is essential to ensure effective national policy is in place and supported by targeted service planning. As Deputies will be aware, given the majority of nursing homes are under private ownership, there is no system in place to gather this necessary data. It is important to underline that any data collected will not be at an individual level and robust safeguards are in place to ensure that any data that may lead to the identification of an individual will not be shared or published.

The Bill also provides for an important change to the definition of those eligible to be considered as a family successor to a family farm or productive business assets under the nursing homes support scheme. This amendment is being sought to extend the definition of those eligible to be considered as a family successor to include cousins, great-nephews and great-nieces, and great-grandchildren as per a Government decision of September 2023.

The Bill reads as "first cousins", which is problematic. Deputy Cahill indicated he would submit an amendment. I do not want the Bill to be restricted to first cousins because a first cousin would potentially be around the same age as a bachelor farmer or bachelorette. It is, therefore, very important that the Bill covers cousins, second cousins and third cousins. There are also once-removed cousins. I do not want to disallow anyone, including an individual with no other family member. We came across three instances where that was the case. We will work with officials to get that over the line with Deputies' support. The rationale is to allow farmers and business owners who choose a family successor, who may be available in a limited or non-existent way under current legislation, to avail of the three-year cap. This amendment satisfies the policy objective of safeguarding the viability of a farm or business and allows equity in accessing the fair deal scheme.

I will speak about some other significant and related developments. I am pleased to announce that I have secured Cabinet approval to publish the general scheme of the health (amendment) (licensing of professional home support providers) Bill 2024, which will introduce a new licensing framework for home support providers. This means that service users who receive home care in their own home can be assured of the same minimum standard of care wherever they live. This framework will be supported by the national quality standard, which will be developed by HIQA. HIQA’s chief inspector will be responsible for independent monitoring and assessing compliance of registered home support providers.

It is also worth noting that the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 provides a legislative framework for a number of important patient safety issues, including the mandatory open disclosure of a list of specified, serious, patient safety incidents that must be disclosed to the patient and-or their family, and the expansion of HIQA’s remit into private hospital services. Section 64 deals with investigations by HIQA where the agency believes there is a serious risk to the health or welfare of people receiving a particular service. The Act was passed by both Houses of the Oireachtas and signed into law by the President in May of last year. Prior to commencement of the Act, a number of preparatory steps are required. These are currently being progressed and significant multi-stakeholder engagement has been taking place across the health system. Work with key stakeholders, including the HSE, the State Claims Agency, HIQA and the Mental Health Commission, is nearly complete. Once these steps have been completed, the intention is to commence the Act at the earliest possible date. I know many Members will welcome that.

A number of Deputies drew attention to the important topic of adult safeguarding, which is a key objective for me as Minister of State. The development of a new national policy for the health and social care sector is now at an advanced stage of development. In January, I published my Department's policy proposals on adult safeguarding in the health and social care sector for a public consultation which closed last month. At a wider cross-sectoral level, the Law Reform Commission has recently published a comprehensive and wide-ranging report, A Regulatory Framework for Adult Safeguarding, together with draft criminal and civil legislation. The Department of Health looks forward to working in partnership with all relevant Departments in analysing and considering the commission's recommendations.

On patient advocacy, I have ensured the continued expansion of the service, which is a national service commissioned and funded by the Department of Health. The Patient Advocacy Service provides a free and independent national service, which helps people using healthcare services to make a formal complaint regarding the care they have received. The Patient Advocacy Service was extended to private nursing homes from 1 November 2022. Legislation was amended to support this roll-out and streamline complaints in December 2022. That service was previously only available in the public sector but has now been rolled out across the private and voluntary sectors.

As Deputies are aware, significant work has taken place on the recommendations of the strategic workforce advisory group on home carers and nursing home healthcare assistants. I reassure them that HSE home support staff recruitment is exempt from the current employment control measures, where the posts are to facilitate discharge from hospital. The HSE has also encouraged its chief officers, where appropriate, to consider increasing the hours of current home support staff who may have additional capacity. If they are contracted for 39 hours, for example, but may only be working 18, 20 or 22 hours, they are entitled to work up to their full contract. All home care offices have been written to in the past few weeks. It is very important that if people have capacity to deliver more home care within the HSE, they will be allowed do so within their contract. It is encouraging that recruitment continues among private and voluntary providers who deliver approximately 60% of home support.

Notwithstanding many of these challenges, I note that Ireland has the highest life expectancy in the EU, as determined by the World Health Organization. We were also formally recognised as the first age-friendly country in the world in 2019. These are remarkable achievements and are to be celebrated, but there is a lot more to be done. Once again, I thank Deputies for their contributions on the introduction of the Bill to the House. I look forward to working with colleagues across the House to progress this important legislation through the Dáil as quickly as possible. I commend the Bill to the House.

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