Pádraig Rice (Cork South-Central, Social Democrats) | Oireachtas source

I congratulate the Minister and Minister of State on their new roles. I will begin by flagging a general concern I have. This is the second week in a row we have had general statements on healthcare. Last week we spent two and a half hours on statements on mental health. As a new TD I found it a very frustrating experience. Not a single question posed during the session was addressed in the closing statement by the Minister of State. I asked whether the new Government would commit to providing 10% of the overall health budget to mental health as provided for in Sláintecare. We got no answer to the question. Perhaps we will get an answer to it today. When there were no answers to the questions, I was left wondering what was the point of the debate and why we spent time researching and preparing. Instead of general statements I wonder whether parliamentary time would be better spent on questions and answers with the Minister, through which we could have real engagement on the issues faced by people. Better still, we could progress the backlog of legislation, including the mental health Bill and legislation on adult safeguarding. Safeguarding Ireland has been calling for legislation for ten years. There is also the issue of a statutory right to home care, vaping legislation, dental legislation, the Health Information Bill and amendments to the assisted human reproduction Act. I will be interested to hear the Minister's thoughts on how best we can use this parliamentary time together to improve health outcomes for people. If we expect improved productivity from the health services we should expect improved productivity from Parliament also.

The app is the minimum we can expect. It is 12 years since we had the first strategy on e-health. In 2023 Ireland was ranked one of the worst countries in the OECD for digital health. The majority of EU countries have e-health records. We are far behind our peers and we need to make progress.

I asked for examples where we could have more gentle care. I went to the briefing earlier from CARED Ireland on eating disorders and the experiences of the families were harrowing. There was particularly powerful testimony from Paula Crotty. If the Minister has not done so already, I encourage her to meet with these families and engage with them. Some of the testimony was very moving and they need specialist care.

On the topic to hand, on longer lives, the census in 2022 revealed that our population increased by 8% in 2016, with the highest increase in the over 70s by 26%. Undoubtedly this is a success story first and foremost but it should also put policymakers on notice. After all, this trajectory will not change and it is only going to accelerate. According to the ESRI, the number of people aged over 70 is projected to increase by 94% between 2015 and 2030, and by 2051 the population of those aged over 80 could increase by 270%. More of the same is not going to cut it. We need to completely rethink the way in which we deliver services to older people to ensure they can live fuller lives and more independent lives.

As I mentioned, the key to this is the statutory right to home care. Staying at home with supports is associated with better health outcomes and it is what most people want. However, successive Governments have failed to provide for this right. On paper the State's policy is to keep people in their homes but in practice the State is funding people to go into nursing homes, 80% of which are in private hands. The overreliance on nursing home care does not serve the interests of most older people. Instead, it serves commercial interests in a sector that is increasingly financed by international investors, while smaller community-based nursing homes, which should be protected, are on the verge of extinction. The problem with this model of care was brought into sharp focus during the pandemic but the financialisation of elder care continues. Contracting out public services is often thought to result in efficiencies but the argument does not stand up to scrutiny. This is because most of those supposed efficiencies have costs and they are largely borne by service users and workers.

Related to this is the urgent need for robust safeguarding legislation. Shockingly, it is still the case that HSE social workers do not have the right to enter private nursing homes, which account for 80% of the nursing homes. Three years ago Safeguarding Ireland warned the Government that HSE safeguarding and protection teams were operating in a legal vacuum but nothing changed. This is inexcusable. A country with a history of institutionalisation and abuse should know better.

Another issue that is often overlooked is that of loneliness. The WHO tells us it is a pressing health threat. The situation in Ireland is particularly bad. In 2022 a European Commission study found that 20% of Irish people felt lonely most of the time compared with 13% of other Europeans. While loneliness is a problem for all age groups it particularly impacts on older people. Just this week the chief executive of ALONE called for a loneliness action plan. This is notably absent from the programme for Government despite previous commitments that were not delivered by the previous Government.

It is disappointing that the programme for Government does not commit to reappointing a commissioner for ageing and older people. The Minister of State, Deputy Butler, said the proposal would be considered by the commission on care for older people. I must say this response misses the point. In referring this proposal to the commission the implication is that older people are purely receivers of care and do not have rights beyond the Department of Health. A commissioner on ageing and older people would have a much broader remit that would recognise the full capacity and potential of older people. I am speaking about the full spectrum of needs and rights in terms of health.

I accept this debate is primarily concerned with health care and ageing but the focus should be wider. The Dáil should be more concerned with delivering a rights-based approach to ageing policy and services. This would include not just health but housing, transport, income, connectivity and education. Ultimately, I fear this rights-based approach to ageing policy and services will remain purely notional. We need to get down to work and pass some of the legislation I mentioned at the beginning of my contribution, which would have a real and meaningful impact on people's lives, provide the rights-based approach that is so badly needed and, ultimately, provide general universal healthcare for everybody.

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