Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank Deputy Healy-Rae for his comments on abolishing the means test for carers. We are systematically trying to get to the point where it has been abolished. I recognise the changes that have been made because what we want to see, as the Deputy said, is people staying in their own homes for as long as possible for their dignity, comfort and connection with their families and because that is the model we want to have. There is a substantial body of work on that, which the Minister of State, Deputy O'Donnell is leading. I thank him for his work on that.

This is an exceptionally important time to discuss this issue again in the House, recognising our collective focus on making sure that people can stay at home for as long as possible, that those who are in nursing homes are safe and have dignity, and that we see a significant change to what we saw in recent weeks. I thank the Labour Party for bringing forward this motion to give us the opportunity to discuss it. To clarify, in opposing the motion, we do not claim there are no challenges in the sector or anything of the kind, but rather we are taking the opportunity to set out the pathway for which we should be held to account in the next number of years.

It is fair to recognise that nursing homes in the public, private and voluntary sectors play a critical role and will retain a critical place in the provision of long-term care and other services. They will remain a vital part of the continuum of care into the future and we have to make sure all the other services are in place so that it is an appropriate part and not an over-indexed part of the continuum of care for older people.

I also need to acknowledge the "RTÉ Investigates" programme that was broadcast on 4 June. I echo the words of the Minister of State with responsibility for older people, Deputy O'Donnell, by stating in the strongest terms possible that every nursing home resident deserves and should expect the highest standards of care and dignity 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 and cannot be tolerated, nor can it be tolerated in any other setting.

I do not wish to repeat what he said, but I acknowledge that in his opening speech the Minister of State outlined a range of actions the Government is taking, which we hope will contribute significantly to improving the nursing home sector and care of older people. I thank him for his always forensic approach to the data he has and for his interrogation of what he believes needs to be done. I have witnessed and, I hope, supported him in that forensic analysis with HIQA and others about the work done to date and what is yet to be done. A fit-for-purpose regulatory regime for the sector is of paramount importance. As the national independent regulator for nursing homes, HIQA and the office of the chief inspector need to use all the powers available to them and to communicate with us about how we can enhance and develop those powers. The Minister of State, Deputy O'Donnell, outlined that he and I have met HIQA a number of times in recent weeks to try to further those ends. HIQA has acknowledged the importance of examining its processes and methodology and will undertake a review of the effectiveness of the chief inspector's inspection and monitoring processes.

One of the things the Minister of State, Deputy O'Donnell, and I identified in particular is the need for more real-time reporting of how that may be done. The update must also be provided in March, for example, if a report is published in March for an inspection concluded in October. There should be a follow-up measure to check what may be outstanding at that point.

I would also expect the same in respect of hospital inspections, a number of which I reviewed this week. Where there are points that need to be followed up, I would prefer to have a real-time assessment of those. We have very strong confidence in HIQA, notwithstanding what has happened over the last number of weeks, because of its institutional experience and the role it has played to date. It is always going to be the case in any developed liberal democracy that we have to assess strongly the institutions we have, even those that have worked very well, and continue to work to improve them, particularly as the circumstances around them change. That is especially the case in respect of the ownership of nursing homes and how that has evolved over the last period.

The Government is fully committed to introducing an adult safeguarding policy for the health and social care sector, which will provide a framework for strengthening safeguards across all private, public and voluntary services. The policy is at an advanced stage and our intention is to bring it to the Government as a matter of priority. My hope is that would be before the August break. To update the House, the Minister of State, Deputy O'Donnell, and I met the Law Reform Commission in respect of that yesterday and we looked at some of the detail, thinking and analysis that went into its report as it considered various models of how to get to the point of achieving a policy that is going to be effective, independent and capable of being introduced quickly. We had a good opportunity to tease through some of those issues. I respect the work of the Law Reform Commission, the very considerable effort it has put into developing its policy and the draft Bills it has produced. The Minister of State, Deputy O'Donnell, and I had a good opportunity yesterday and we will reflect on that as I bring the policy direction to the Government over the next number of weeks.

The policy will set out, at a high level, proposed new legislative provisions for the sector. It will also set out a wide-ranging programme of non-legislative measures across our sector to achieve a culture of safeguarding that is fostered and embedded at all levels. More broadly, it is important to reiterate that investing in services for older people is a Government priority and has been. There has been an increase of approximately €1 billion in funding for services for older people since 2020. This year alone has seen an increase of approximately €350 million on the amount secured under budget 2024, bringing the total figure to almost €3 billion in budget 2025. A figure means nothing without a context but, of course, that is €3 billion out of an overall budget of €25 billion. There is significant investment but that does not mean we do not need to continue to do better, particularly at a time when there is a growing and ageing population. Deputies are already familiar with the measures in the nursing home support scheme known as fair deal. That fair deal scheme will receive Government funding of in excess of €1.2 billion this year, and the programme for Government commits to strengthening the nursing home sector by increasing funding for fair deal. It is important that we continue to work on that.

The programme for Government also commits to building more public nursing home beds and that is an absolute priority for this Government. The 2025 programme for Government is, I hope, dedicated, among other things, to the vision of creating a caring society, a compassionate State and one that is funded to be able to do those different things. We are trying to advance a range of actions that will genuinely advance the social care model, and support older people to live a full and independent life in their own homes and communities with appropriate wraparound supports.

Another element of that, which is so important, is our increasing use of virtual technology in the healthcare sector more broadly to enable people to get appropriate care as close to home as possible, always with a view to keeping people in their own homes and spaces for as long as possible, recognising all of the different challenges that people have. While our commitments in respect of Meals on Wheels, nursing homes and a range of different issues are challenging, I believe they are achievable but I have to reiterate to the House the scale of the demographic challenge that is ahead. We are going to have to think about and work together on it in every possible way.

Our population is growing rapidly and it is ageing. That is an extremely good thing. It is fantastic that people are living longer lives in Ireland and that our life expectancy is increasing but it will bring a different challenge for all of us here to be able to support and represent people in an appropriate way. We will have to recognise that people are going to be diagnosed with more illnesses as they age. Again, this is a good thing, as opposed to the alternative. Nevertheless, the intersection of those illnesses with where they live and how they are supported is something we are going to have to concentrate our minds on, while making sure we are using every lever in both the healthcare and social care sectors to support people at home. That is a good thing for people's dignity and for the economics of supporting people, which must also be there. Very happily, these things coincide. I look forward, over the period of this Dáil, to working with all Deputies to try to achieve those different goals.

In conclusion, let me go back to the essence and purpose of this debate, which is prompted by the desperate and dreadful scenes we witnessed in the recent RTÉ programme, which highlighted appalling deficiencies in care and with respect to people's dignity in some long-term residential care settings in Ireland. Of course, primary responsibility absolutely lies with the individuals who committed those actions, and the organisations that worked in a way that enabled or facilitated them, or did not intervene or address them. It is also the case that we have to improve HIQA's processes and standards but we must never lose sight of the fact that everybody has a choice about how they turn up to work and how they treat people on a day-to-day basis. Those choices were very wrong in every instance we saw on that RTÉ show. It is simply unacceptable and I think we are absolutely unanimous in our perspective on that.

The Minister of State, Deputy O'Donnell, and I have a range of work to do, on which we will continually update Deputies, and they will hold us to account on that. I thank Deputies for the opportunity to discuss this today.

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