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

Last week on the Order of Business I raised with the Taoiseach that seven years ago, as Minister for Health, he gave a commitment to introduce a statutory right to home care. Given the failure of that Government and the current Government to follow through on that commitment I asked for a debate on that issue today.

We have a debate, but it is not on the statutory right to home care. It is on statutory home care provision, which is a very different matter. What we are talking about today is regulation, and while regulation is important, it is not the issue. The issue is that people were promised a statutory right to home care, and neither this Government nor the previous one has delivered on that.

This issue was first brought to my attention by Brendan Courtney a number of years ago, because Brendan and his family found themselves in a situation where his father needed care. He was becoming increasingly disabled due to illness and he needed care. The family wanted to care for him at home, and they discovered they were not supported in doing that because funding for home care was not available. They were all prepared to put in the time and effort to do that but they needed support from the State. The only support the State could provide was nursing home care, under the fair deal scheme, but that is not what they wanted at all and Brendan did a lot of work to bring attention to this matter.

We know that older people want to stay in their own homes for as long as possible, and we know that from a health and well-being perspective they do best in their own homes, yet the State will not support that choice or that optimal arrangement for older people. Instead, over recent years since the fair deal was introduced, older people have been directed into nursing home care. They are being funnelled into nursing home care in the absence of adequate support for them to stay at home, and that system is not serving the interests of older people. Indeed, I cannot help but think it is a system that serves the commercial interests of the nursing home sector, and that is not what we should be doing.

Home and Community Care Ireland recently provided an insightful timeline about this issue, going back to 2016, eight years ago, when the programme for Government of the day committed to introducing a statutory, legal right to home care. The following year, the then Minister for Health, Deputy Harris, advocated strongly for that and said he was going to introduce such a statutory right. In 2017, Department of Health officials said they were working on a legal entitlement, along with regulation of the sector. In 2018, there was an extensive consultation on this and a large number of responses were given, which were predominantly in favour of introducing a statutory right to home care, making it at least a level playing pitch in order that we would not force older people into nursing homes but would look out for their best interests. In 2019, we were told by the then Secretary General of the Department that a statutory entitlement was an absolute priority and that it was going to be introduced shortly. In 2020, Deputy Harris, as Minister for Health, said the scheme was nearly ready. We heard the other day from officials that work on the regulation only started in 2020, so I do not know what the then Minister for Health, the current Taoiseach, was talking about in saying the scheme was nearly ready, because clearly that was not a true statement. In 2020, Deputy Butler, as the new Minister of State with responsibility for the matter, committed to implementing the statutory scheme by 2022. Here we are, two years later, and we are really no nearer to having that legal entitlement to home care. Much has happened since then, but there was not a clear commitment. Last year, the commentary from the Government changed to being about regulation of the largely privatised market for home care, but there is very little talk anymore about a statutory right to home care and that is where the difficulty arises.

If we have learned anything, we should have learned from the experience of Covid, the appalling situations that arose in nursing homes and the appalling numbers of deaths that took place in them because of congregated settings. At the time, the then Taoiseach, Deputy Varadkar, said in reply to me in the Dáil that we needed a new model of care and that large-scale nursing homes were clearly not in the interests of older people. At the same time, the then Minister, Deputy Harris, said the large-scale commercial nursing home model was not fit for purpose. Here we are, four years later, and virtually no progress has been made on developing a new model of care for older people. This is in spite of the fact all the advocacy groups, such as Sage Advocacy, Alone and many others under the umbrella group of advocacy organisations, have looked for a statutory right to home care. They want a new model that is about supporting older people in their own homes and looking at alternative housing models with support in order that people can stay at home and thrive in their local community. We are no nearer to that. The regulation is important, but why has the Government not delivered on the promise that has been made for so many years?

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