Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)

Last week, we witnessed highly distressing scenes of neglect and abuse at two Emeis-operated nursing homes in Dublin and Portlaoise. These were scenes the Government had long assured us were consigned to history. First and foremost, my thoughts are with the individuals and families affected. I hope counselling and health services have been made available immediately to them. If not, the Minister of State must ensure this is done today. I also commend Clare Doyle and the various whistleblowers who contributed to the unearthing of the abuse of the residents of the nursing homes. Clare's words were exceptionally powerful and deserve repeating. She said she felt as though she was having one of those dreams when something awful is happening and you are screaming into the abyss. She described it as feeling that desperate because she knew the real human suffering that was happening. She continued, "These are our parents, our aunts and our uncles. As a professional, I was shocked, I was angry. As a human being I was heartbroken."

These revelations of systematic institutional abuse at residential home care come 20 years after Leas Cross and ten years after Áras Attracta. In the intervening years, scandal after scandal has underlined the inadequacy of existing legislation, with a major gap in the law in the absence of an adult safeguarding Act and insufficient resourcing and empowerment of safeguarding teams. Emeis Ireland is the largest nursing home operator in the State. In recent years, it has expanded to more than 2,400 nursing room beds across the State.

Astonishingly, the Government has allowed this to happen despite revelations of widespread abuse at the company's centres in France. HIQA has inspected multiple Emeis-run homes and has identified repeated non-compliance across its reports. Malnutrition was a feature echoed across the report and the RTÉ documentary clearly identified not only understaffing but gross misconduct and total disregard for individual care plans. The staff were not being governed properly and poor practice was clearly routine. Poor practice seems to be the standard that was expected and encouraged.

The residence in Portlaoise is only one example of how Emeis runs its nursing homes in Ireland. The residence has been inspected on multiple occasions by HIQA and on no measure in the latest report was it found to be fully compliant with regular standards. It was not only non-compliant but repeatedly non-compliant, with little evidence of even trying to improve its standards. HIQA found that the provider had failed to implement the compliance plan submitted following previous inspections and that the overall governance and management of the centre had deteriorated since the previous inspection. Most worryingly, staff were unaware that a resident at high risk of malnutrition had been reviewed by a dietitian in January and as a result, interventions to manage nutritional risks were not completed. In layman's terms, people at the home were suffering from starvation and neither management nor the owner seemed to care or even inform staff of changes to care plan. Malnutrition, to an ordinary person, is a major red flag. Food is a basic requirement for survival. Without that, what hope have you got? Yet, it seems nothing happened to stop this. There were no financial penalties or closures.

The RTÉ documentary made clear that care plans were not being used appropriately, if at all, and certainly were not being referenced when decisions were made on staffing and resourcing. HIQA found repeated failures to ensure that staff were appropriately trained and supervised and identified that records were not being managed in line with regulations. It even found that records relating to family complaints were not being documented. RTÉ revealed that Emeis was plámásing families with tales that it would improve services but nothing in practice was changing.

I am particularly taken by this quote from the CEO of Emeis: "Our jobs are profoundly human. Each of our gestures, each of our actions has a direct impact on the residents". What were those impacts? They were bedsores, bruises, calls for help going unanswered, starvation, deprivation of liberty, a lack of dignity, a lack of respect and a lack of care. How did operator get away with it? Is it because the operator knows how to play the system to make sure that enough staff are around when there are inspectors or visitors but are then cut to a skeleton crew when nobody is watching? It seems to know what to say and when to say it but does something entirely different when it thinks no one is watching.

The problem at the heart of all of this is privatisation and the consolidation of nursing home care in large, multinational, for-profit corporations. Over the past few decades, Fianna Fáil and Fine Gael have gutted the public residential care sector in favour of private homes. More than 80% of residential care for older people is now provided by the private sector and this is rising every day. That is not a criticism of private nursing homes. There are many fantastic local centres run by honest people who provide top-quality care. There are many fantastic nursing homes around the country but there are far too many homes run like prisons, maximising profit instead of making sure they meet people's needs. To even call what we saw last week prison-like conditions does these residents an injustice. These conditions are worse than prison and are a total deprivation of liberty. These are supposed to be people's homes but what we saw was anything but a home. It could be any one of our loved ones suffering from it.

Deputy O'Donnell's first job, as Minister of State responsible for older people, is to get safeguarding legislation done. The Government has been prioritising this for years but has done nothing. This legislation must establish an independent safeguarding authority with real powers and resources to act on individual clinical concerns. There must be mandatory reporting of concerns of abuse and neglect. HSE safeguarding teams should be brought under the remit of this authority and they need to be significantly expanded to do their job. Safeguarding teams and social workers must be given a legal right of entry and permitted to investigate concerns unannounced at any time, and where management and corporate leadership make decisions that lead to poor-quality care and the loss of the health or life of residents in the care of services they are responsible for, there must be accountability. There has to be accountability, not only at staff level but at organisational level. There are failures to govern safely, such as those identified in the "RTÉ Investigates" report. There must be a step change in investment in public nursing home capacity to reverse our over-reliance on the private sector.

The Minister of State must also engage with smaller operators and community homes to see what they need to stay viable in an increasingly complex sector. Care for older people, and for the Minister of State and me as we age, is in need of radical change. He should review the mandate of the commission on care and ensure it can future-proof the model of care for ageing and he must develop a comprehensive social care policy to support independent living.

Sinn Féin has proposed a home-first approach to care backed by a statutory home care scheme that forces the system to redirect resources to home care. It is essential that the Minister of State get the statutory home care legislation right. The current Bill before the House does not go anywhere near far enough. Home care must be prioritised. This will have profound implications for the nursing home sector as the complexity of people's needs will rise. We must empower people to live full, independent lives, not only adding years to life but adding life to years. Last week, the Taoiseach defended the existing regulatory system. He said laws are in place to deal with this. Those laws are clearly not working, and everyone has been telling the Government for nearly 20 years that they are not enough.

In my previous role, I was a carer for 18 years. For 18 years, we gave the best of care. There are people who are cut out for these jobs; not everybody is made for them. On what I have read in the reports, in my previous role, when inspectors came in there were two of them for two days. We had three residents. We had care packs. It takes a long time to go through them. I would have had 100% faith in them until I read those reports. I have read the four reports. There was one person on one day for 24 patients. The final report involved two people for two days for 70 patients. That is not enough.

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