Kieran O'Donnell (Limerick City, Fine Gael)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following: "recognises that:

— a national policy on adult safeguarding will be introduced for the health and social care sector, as set out in the Programme for Government, and this policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of existing legislation, policies, and procedures already in place in the sector for preventing, reporting, and responding to abuse;

— a framework for safe nurse staffing and skill mix will be developed for nursing homes, and this framework is a systematic, evidence-based approach to determine the number of nurses and Health Care Assistants required to provide safe and quality care, based on patient need/dependency; and

— the remaining provision, Section 68 of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, will be commenced, providing additional powers for the Health Information and Quality Authority (HIQA)/Chief Inspector with regard to serious patient safety incidents in nursing homes, and the Chief Inspector will have the power to carry out a review of an incident which may have caused an unintended or unanticipated death or serious injury to the patient, and which occurred in the course of the provision of care to that patient;

notes that:

— a review will be established of the effectiveness of the Chief Inspector's inspection and monitoring processes, and this review will include such elements as how to further strengthen the monitoring of leadership, culture and governance in designated centres, how to better capture indicators of staff culture and other areas of service delivery, which is critical for safe and good quality support for residents;

— a plan for additional public nursing home bed capacity will be published, and the Department of Health, alongside the Health Service Executive, is currently developing a new public long-term residential care additional capacity plan, which will be published in 2025, and the delivery of additional public long-term residential care capacity is required to deliver on Programme for Government, Sláintecare, and Project Ireland 2040 commitments;

— new design standards for long-term residential care settings for older people across all sectors will be created, describing what good building design looks like for long-term residential care settings for older people, and providing a common benchmark against which the standard of these settings can be measured, and the Department of Health report entitled 'Design Guide for Long-Term Residential Care Settings for Older People Public Consultation Report', was published in January 2025;

— ownership structures will be reviewed to enhance transparency and strengthen accountability in the long-term residential care sector, and carrying out an evaluation of the implications of complex corporate ownership structures against current regulatory powers will identify opportunities for regulatory reform;

— the Government has reiterated its well-established commitment to the development of the statutory home care scheme in the 2025 Programme for Government, and the first element in delivering this is the Health (Amendment) (Licensing of Professional Home Support Providers) Bill 2024, which will establish a licensing framework for professional home support services and provide for regulation by HIQA;

— the Programme for Government commits to strengthening the nursing home sector, by increasing funding for the Nursing Homes Support Scheme, also known as Fair Deal, while investment in Budget 2025 was €67.6 million, and this followed on from an increase in 2024 of €45 million; and

— the Government established an independent Commission on Care for Older People, which is charged with examining the provision of health and social care services and supports for older people, and with making recommendations to the Government for their strategic development, including long term residential care; and

further notes that from 2021 to 2025, the Government provided funding of €21.4 million, to enable people under the age of 65 to transition to an alternative community-based placement and provide in situ supports as appropriate.".

I welcome the opportunity to address the House on matters raised in respect of nursing homes in the Private Members' motion tabled by the Labour Party. I do not doubt Members' sincerity in bringing it forward. We all want to get to a point where we have a better, fitter nursing home service for the elderly.

I again acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. That hard-hitting and harrowing programme highlighted a litany of poor care standards in two nursing homes, namely, the Residence Portlaoise and Beneavin Manor in Glasnevin, and showed clear neglect and abuse of older people. The welfare of both the residents and their families was obviously at the forefront of my concerns following the RTÉ programme. I am very conscious of the impact the programme will have had on the residents, their families and the staff in the nursing homes featured in the broadcast. I am also conscious of the impact it will have had on the nursing home sector more generally, including residents and staff. It is important to acknowledge, as all speakers have, the committed, compassionate and dedicated providers and care staff operating in nursing homes across the country.

Like everyone else watching the programme, I was shocked and deeply concerned at the level of non-compliance with care standards in evidence from the distressing footage that was aired. I again state categorically that every nursing home resident deserves, and should expect, the highest standards of care at all times. Poor care, mistreatment, neglect or any other form of abuse of any person living in a long-term residential care centre is completely unacceptable. I expect the highest standards of care to be upheld by providers for every resident in every nursing home across the country. Anything less than that will simply not be tolerated. I welcome the confirmation that referrals have been made to An Garda Síochána.

I have had significant engagement with HIQA and with key stakeholders in the nursing home sector, including the HSE and representative bodies from the sector. I am continuing this engagement with an immediate focus on delivering the highest quality of care to the residents of nursing homes in Ireland. Responsibility for the safety and care of residents ultimately rests with the individual provider of each nursing home and its staff. The governance and management of nursing homes is a critical aspect in ensuring the safety and welfare of all residents. Staff must be equipped with the tools and supports they need to provide those in residential care with person-centred care.

As the national independent regulator of nursing homes in Ireland, I expect HIQA and its chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. HIQA's role is to ensure the systems, structures and processes put in place by a nursing home work to ensure safe and effective care and support for those in residential care. Department officials and I met with HIQA on 4 June to discuss regulatory activity relating to the nursing homes featured in the "RTÉ Investigates" programme. At the meeting, HIQA's chief inspector confirmed its continuous intensive engagements with the two nursing homes in question.

On 13 June, as requested, HIQA furnished me with an interim report on its engagement with the two nursing homes featured in the "RTÉ Investigates" programme. That interim report was published on 17 June. It details HIQA's inspection of the two nursing homes since the programme was broadcast and its ongoing work in this regard. It also provides a brief overview of the Emeis Ireland group. HIQA has completed a series of unannounced inspections of both nursing homes, in the evening, in the early hours of the morning and during the day, to ascertain the level of care being provided at all times. Both providers were issued with an official warning of cancellation of registration should they fail to implement significant improvements in the care of residents.

On 20 June, as requested, I received a further report from HIQA giving an overview of the 25 nursing homes in the Emeis Ireland group. The report provides a comprehensive overview of regulatory history, including, but not limited to, regulatory compliance, escalating enforcement actions and any additional conditions of registration. That report was published yesterday.

The Minister, Deputy Carroll MacNeill, and I, together with Department of Health officials, met with HIQA on 17 June and on 30 June to discuss both reports. At those meetings, HIQA advised it is continuing its intensive engagement with the Emeis Ireland group of nursing homes. The contents and findings of both reports are being considered, including the need for additional regulatory powers in respect of nursing homes, with actions in this regard to be taken as a matter of priority. I cannot emphasise enough that this is an absolute priority for me and the Government.

HIQA has acknowledged the importance of examining its processes and methodology. It is essential that they are continually reviewed to find ways to improve the inspection and regulation of nursing homes. HIQA is undertaking a review of the effectiveness of the chief inspector's inspection and monitoring processes.

This review will include such elements as how to further strengthen the monitoring of leadership, culture, governance and management in nursing homes, how to better capture indicators of staff culture and other areas of service delivery that are critical for safe and good quality care for residents.

I have requested that, when compliance issues are identified in a nursing home, HIQA monitor more closely the corrective actions taken by the nursing home towards achieving compliance and that this information be included in HIQA's published reports. This makes common sense. When a report is published at present, it deals with what happened on the day of the inspection. I want the report not to deal with the day of the inspection but the compliance actions required to be implemented and whether they were implemented. A report is in real time. When people read inspection reports on the HIQA website, they will see not only what happened on the day of the inspection but also what has happened since. When they are looking for a nursing home for their loved ones, they will know what the situation is now. That is very important. I have asked HIQA to implement this and it will do so.

It is acknowledged that the nursing home sector has evolved in Ireland over the past 30 years from a predominantly State-led service to a situation today where approximately 80% of nursing home services are provided by the private sector. I am fully aware of the investment trends in the Irish long-term residential care market, the growing consolidation of the sector and the complex investment and ownership structures that now exist. Deputies have referenced that in almost all of the contributions. It is, therefore, important that all aspects of the nursing home sector be scrutinised over the coming period to ensure that service delivery and configuration meet the needs of service users in a sustainable and safe manner.

This scrutiny includes a review of ownership structures to enhance transparency and strengthen accountability in the long-term residential care sector. Carrying out an evaluation of the implications of complex corporate ownership structures against current regulatory powers will identify the required regulatory reforms. As it stands, HIQA can regulate the individual company that is the service provider but does not have jurisdiction over the parent company or the umbrella group. I want that changed and we will implement that.

The chief inspector of HIQA will soon have additional powers with regard to serious patient safety incidents in nursing homes when section 68 of the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 is commenced. The chief inspector will have the power to carry out a review of an incident that may have caused an unintended or unanticipated death or serious injury to a patient and occurred in the course of the provision of care to that patient.

The Minister, Deputy Carroll MacNeill, and I are fully committed to introducing an adult safeguarding policy for the health and social care sector, including nursing homes. The policy will commit to the development of adult safeguarding legislation for the sector, including nursing homes, and will build on the range of existing legislation, policies and procedures already in place in the sector for preventing, reporting and responding to abuse. The policy is at an advanced stage and our intention is to bring it to the Government as a matter of priority. The Government has included a health (adult safeguarding) Bill in its current legislative programme to facilitate this, and it is recognised that this will be an important further development in protecting vulnerable adults from abuse.

I would also like to advise the House of ongoing work by the Department of Health to develop a framework for a safe staffing and skill mix for long-term residential care settings for older people. The framework is a systematic evidence-based approach to determine the number of nurses and healthcare assistants required to provide safe and quality care based on patient need. This work is nearing completion, and I expect to receive recommendations for how it can be implemented shortly. Furthermore, in my discussions with HIQA, I have asked it to ensure that, where there is a change in the staff profile in a nursing home, there be a requirement to notify HIQA. This is a very important point. It is a practical measure that can be taken by HIQA.

The Government is committed to continued investment in healthcare infrastructure that supports the highest quality of care for our older population. It is recognised that long-term residential care will continue to be a crucial part of the overall continuum of care. The programme for Government commits to building more public nursing home beds and, in this context, the Department of Health, alongside the HSE, is developing a new public long-term residential care additional capacity plan, which will be published in 2025. The delivery of additional public long-term residential care capacity will deliver on programme for Government, Sláintecare and Project Ireland 2040 commitments. This plan will be informed by the HSE capacity review report on future capacity for older people, which was published on Monday by the ESRI.

We have spoken about the built environment. It is of paramount importance that the built environment and location of long-term residential care settings support high-quality care and positive experiences for our older population. The Government is, therefore, committed to creating new design standards for long-term residential care settings for older people across all sectors, providing a common benchmark against which the standard of these settings can be measured.

Statutory home care is a priority for me. I am working on the legislation for home care providers, which will be the first step. I will look to bring it to the Minister, Deputy Carroll MacNeill, and the wider Government as a matter of priority. We are increasing funding for home care. With regard to the age profile of the population, we have set up the Commission on Care for Older People and it will shortly publish the first module of the work it has done.

I, as Minister of State with responsibility for older people, the Minister, Deputy Carol MacNeill, and the wider Government are committed to ensuring everything possible is done so that the distressing scenes we witnessed in the recent "RTÉ Investigates" programme do not happen again in any nursing home in the country. I want to state clearly that every nursing home resident deserves and shall expect the highest standard of care. My abiding concern is older people in nursing homes. Everything is about improving care and safety for them.

See this speech in context