Marie Sherlock (Dublin Central, Labour)

I welcome that we are having this debate today but we should not be here. I give huge credit to the "RTÉ Investigates" team for putting together that programme. If HIQA had been doing its job, we would not have had to have it. Clare Doyle should not have had to take that enormous step on her part to tell the stories that had been relayed to her. I would argue that we need to hear more from her because I believe she has more to say. To the Guy family in Glasnevin and to the other families of the residents in Portlaoise and Glasnevin, I say that we are all extremely conscious that one of the most difficult decisions any family will ever take is to put a loved one into a nursing home. It is a decision that places enormous trust in strangers to treat that person with dignity and respect in their final years. We have seen a fundamental breach of that trust.

My very serious concern, as I said earlier, is that when all this dies down, the only focus for the Government is going to be ensuring that HIQA tries a bit harder and gets its act together and that we have the added safeguarding legislation. This is separate from the work on home care supports, which is a very important body of work that needs to happen. We will always need nursing homes in this country. If the figures prove correct, we will have more than half a million people over the age of 80 in 25 years' time, including people living in rented accommodation or, as in my constituency, three generations living in a single home. We are going to need nursing homes and we have to get it right.

As I have been thinking about this over the last few days, two things have struck me. First, a raft of reports are sitting in the Minister of State's Department gathering dust. We have a report from 2022 on workforce planning. We have the pilot on staffing. We have the learnings from Covid from 2020. We have the guidelines from the start of this year on the maximum size of nursing home beds. They have all fallen off the bandwagon and off the agenda. There has been no prioritisation in government regarding this, and no action. That has to change. The other key feature is the overwhelming extent to which our State relies on the private sector. When we say "the private sector" we have to be careful, because it is a real mixed bag. It is true that 80% of nursing home care is within the private sector. As my party leader, Deputy Bacik, said yesterday, ten funds now control 30% of nursing home beds. Some 38% of all beds are controlled by large long-term residential companies and they are growing. In the 2000s, we saw the nursing home sector turbo-charged by the tax exemptions brought in by the Fianna Fáil Government starting in 1997 and continuing well into the 2000s. Now we are seeing that REITs are beginning to operate in the sector. They are able to go in as property companies, propcos, and buy up buildings or set up buildings, and then they have what is known as an opco to operate. There is a business model there that is designed to maximise profit, separate out liabilities and exposure, particularly with regard to accountability, and ultimately put our State and most crucially the elderly people in these facilities in an extraordinarily vulnerable position. The State and the Government over the last ten years have done little or nothing to ensure there is increased scrutiny over those facilities.

I was talking to a medical professional yesterday who has long years of service in the nursing home sector, and who has significant funds in the bank. He went to the bank to borrow to purchase a small nursing home in the south of this country. He could not get a loan and that nursing home is now in the hands of a conglomerate. That is happening across the country. There are small nursing home providers, many although not all of which do great work, and they need to make upgrades to their nursing homes. They are being refused funding. Then they find themselves in difficulty with HIQA and we see the closures on the scale we have seen over recent years. Approximately 20% of nursing homes closed between 2020 and 2022. There are fundamental decisions for this Government to make about what type of nursing home sector it wants in the future. In particular, does the Government want the small nursing home providers across the country or not? They are not getting support from the banks and they are certainly not getting support from the State. They would also hold a view with regard to HIQA that there have been kid gloves for the bigger operators and less so for them. That has to be teased out over time but it is certainly an allegation they would make. We have a growing set of market-driven and profit-driven nursing home operators and that has to change.

The key issue in all this is the impact on care. Earlier today I talked about the vast number of people in the private nursing home sector who are on the minimum wage, and the incredible turnover figures of 54% in 2022 among healthcare assistants. We are all talking about the turnover in the childcare sector and other sectors. I do not think the figure of 54% can be beaten across any other industry in the country. There is a reason for that, and it is how they are treated, the lack of resources and all the things we saw in that programme last Tuesday night.

They are being deprived of resources, being made to work extremely long hours and getting paid a pittance. The reality is that this Government has report after report sitting there with regard to how we need to change pay if we are to improve quality. I wish to quote to the Minister of State the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants that his Department put together in September 2022. It has two important recommendations. The first is that "All private-sector and voluntary providers should be invited to give a commitment to pay home-support workers and healthcare assistants, at a minimum, the National Living Wage". The Minister of State's Government has abandoned trying to go next or near a living wage for all workers. What has it done for healthcare assistants in nursing homes? I do not think I have ever heard a reference from this Government concerning this issue. The reality is the operators of the system need to be told they need to put a joint labour committee in place in co-operation with trade unions representing workers and ensure there are proper terms and conditions. The second key recommendation was that there should be "An appropriate mechanism to reach agreement ... in respect of pay and pensions" for the workers in the sector. It is within the power and the gift of the Minister of State to bring unions and those operators into a room and tell them they need to agree better terms and conditions.

The second key issue concerns minimum staffing levels. The reality is that we have minimum staffing levels in the North and in other countries but they do not exist here. HIQA has no requirements with regards to staffing levels. We can only imagine that ensuring sufficient staff are in place is not a priority for those operators that are purely profit driven. It is not a priority when the bottom line is to make a greater number of bucks. It is not a priority when ultimately there is a race to the bottom. We are talking about our loved ones here. We are talking about our older people who are very vulnerable and need respect, care and dignity. We are not talking about looking after tins of tomatoes or something else. We are talking about real people here and the State has reacted by not putting down minimum staffing requirements. The reality is that if we do not do so, we are going to continue to see these crises occurring time and time again.

There has been a pattern from Leas Cross to what was revealed about the private nursing homes and how many of them fell apart during the pandemic to what we saw on our screens last week. It is that private nursing homes have not found themselves well equipped to be able to deal with situations when a crisis hits. We again have reports from the Minister of State's Department with recommendations as to how to better equip them in future. It is the State's role to do it. Crucially as well, however, the State must take a leading role now. Is the Minister of State comfortable with the level of private sector provision of nursing home care in this country? Is he comfortable that we are entrusting the care of our loved ones - older people who need respect and dignity in this State - to very large operators whose sole motivation in many cases is profit? Is he comfortable that people are being paid the national minimum wage while looking after vulnerable people in this State? If he is not comfortable with this situation, we need to see action please. This is not just about HIQA, and it is not just about ensuring we get the home care support scheme in place; it is about ensuring the Government puts legislative provisions in place. I see that in the Health (Miscellaneous Provisions) (No. 2) Act 2024 there is provision, I think it is in section 101B(3), for the Minister to prescribe that information be furnished by nursing homes and other centres to a chief inspector with regard to persons employed and details of employment. There have been no regulations in this respect and we need to see them as soon as possible.

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