David Cullinane (Waterford, Sinn Fein)

As was said, the first priority should be ensuring people are cared for in the home and in the community. The difficulty is that many older people are waiting for intensive home care packages. In the previous term and the previous programme for Government, the then Government promised a statutory home care scheme. It never the light of day. I am not sure when that will ever come. I suspect it has not come because we simply do not have the capacity in home helps, home care hours and home support hours to deliver it. At the moment, even without a statutory home care scheme, that is under pressure and people are waiting too long. I learned from the response to a parliamentary question I tabled some weeks back that there are people who have only partial hours or a portion of their hours even though they have been allocated more. Of course, the first priority is that people are cared for in the home. For people to be cared for in the home, however, we have to provide the supports to enable it to happen, particularly when there may be complex needs.

However, there are circumstances in which, unfortunately, people need to be in residential care homes. That is just a fact of life.

Another fact is that, over the past 20 years, we have seen a drift away from public providers to private providers. We are aware that the ratio of public nursing home capacity to private nursing home capacity has turned on its head. Almost 80% of homes are now private. If that is not bad enough, family-run operators, or what were called “mom and pop operators” ran out of the market, having been bought up by funds that are now providing a service across multiple homes. We have heard from HIQA that there is an issue in this regard. The funds are complex legal entities with deep pockets that can end up out of the reach of regulation. I am referring not to the homes themselves but to the parent companies. We have also heard that regulations will need to be changed to deal with this. I accept that and believe HIQA has to be given the powers. Although the Minister correctly said at a meeting of the health committee last week that there are powers to fine nursing homes, cases need to go to court. HIQA itself should have the power to impose fines.

Before the Government moved on this, I was very supportive of the idea of HIQA being able to issue compliance orders and I worked with the authority on it. That is fine because we do not want the only option to be the deregistration and closure of a nursing home. We want to have various options along the way. There are not enough. There is a need for fines and penalties, particularly where there are instances of neglect and abuse of the kind we have noted in some nursing homes. It is quite extraordinary that while there were almost 200 allegations of abuse in one home, not one cent of a fine was paid. That is really upsetting for people.

I want to deal with an aspect of a HIQA report published yesterday that concerns my constituency. HIQA inspectors pointed out that omissions or errors in care delivery were leading to many problems. It is reported that in a County Waterford care centre, inspectors were not assured that the registered provider had taken all reasonable measures to protect residents from abuse. According to the report, some residents with a history of behaviours which were a known safeguarding risk to other residents had measures documented to mitigate the risk but these measures had not always been effective and failed to protect residents from abuse. It states this finding was evidenced by “the continuance of physical and verbal peer-to-peer abuse incidents by a number of residents in the centre”. This shows in black and white, or in very stark terms, that we need safeguarding legislation for adults. Although I might sound like a broken record, I have to keep making that point because, from all the crises in care centres, disability centres and nursing homes, and potentially also in homes, where there can be abuses of older people, we realise we need to have the very highest and most robust protections. Our aim has to be high-quality care. To achieve high-quality care, there cannot be any hiding places. There has to be mandatory reporting, an automatic legal right of entry for social care teams, and statutory safeguarding legislation so there will be real muscle and power. We have done this for children, and rightly so, and we now need to do it for adults as well. It is long overdue. It is all well and good that the Government is saying a policy review will go to the Cabinet but it does not cut the mustard with respect to safeguarding legislation. Again, I appeal to the Minister of State to prioritise this.

The health committee agreed today that I would become a rapporteur to consider what safeguarding legislation would look like. I hope that will be of use to the Minister of State as the Government prepares legislation.

See this speech in context