Mattie McGrath (Tipperary, Independent)
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Universal healthcare is a healthcare system in which all residents of a particular country or region are assured access to healthcare. That is currently a pipe dream in this country, unfortunately. Our health system is broken, and I do not know what it is going to take to fix it. How are we getting the most basic things like providing our citizens with a decent level of healthcare so wrong? We currently have a health system in which our most vulnerable children and adults with disabilities are waiting years for the most basic of therapies and early interventions. Speech and language, occupational therapy and psychology appointments within the children's disability network teams, CDNTs, are practically non-existent, with hundreds of children in south Tipperary waiting to be seen. Therapists are fleeing the service, which makes it worse. Waiting lists for primary care appointments are no better.

In recent weeks, I have brought serious issues regarding the governance of the child and adolescent mental health services, CAMHS, in Tipperary to the attention of the Minister of State and head of services. These are very concerning with regard to the management and practices within the organisation. The concerns that have been brought to my attention are extremely worrying, and the most disappointing thing about all this is that our young adults are going through a very difficult time in their lives with mental health difficulties. They are the ones who are losing out, and there does not seem to be any rush to fix the problem, which is desperate. Is uafásach an rud é sin. Our children are waiting five years for orthodontic appointments. Now, the HSE is actively encouraging patients to bring their children to the North for treatment under the cross-border directive.

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We are sending our pensioners to Belfast for a 15-minute cataract operation because we cannot do them for years, while people waiting for knee, hip or other such appointments have a choice between years of pain and suffering or driving to the North. My friend, a lady of 83, Katie Peters, is travelling tomorrow to get a hip operation. I wish her well. She is frightfully nervous. She is a kind, gentle woman, like a second mother to me. She is so nervous about the travel and the distance involved. Thankfully we can get this service, but it should not have to happen, but it is happening all the time. My colleagues, Deputies Collins and Healy-Rae, and others, send people all the time to Kingsbridge hospital in Belfast and elsewhere for a plethora of different reasons. I thank them because they often pick up patients in Cahir, Mitchelstown and indeed Cashel for me, to bring them up. They come back and have praise of what is done there. The farce of it is that people from Northern Ireland are coming here under the same scheme to get it done here. How could a system be so disjointed that it could carry on that kind of calamitous route, with absolutely no accountability?

As I said during the week, I have been in St. Vincent's public hospital recently. I got the best of care. I want to acknowledge that there are many good things. I went in the front door and came out nearly a week later. I was back several times for follow-up appointments. It was professional and streamlined, with very little waiting time. How can it be so chaotic in other areas? I also acknowledge that I attended the Mater too, with Professor David Keegan. I was with him this day week ago. He and his colleagues have a great vision - vision is not a pun but it is very important - of how we can make things better here for eye treatments and cataract operations. We looked at the Sligo model, which was a success. He told me last week that he is half half-tempted to give up because he is meeting resistance, blockages and roadblocks that he had never anticipated. He is a professional surgeon of high renown and he and his colleagues want to do their job. They should not have to lobby and come in for meetings with the HSE to get the dynamic services that they want to provide. They are showing a pathway but there is too much red tape and too many fiefdoms, a word which I use again, within the HSE and Department of Health. People are minding their own patch and not serving the greater good, as all public servants should be.

We badly need a good, strong Minister, which we do not have, to take on this system and give it a good shake-up and make it work for our people. It is getting worse rather than better. I regularly hear the Leas-Cheann Comhairle talking about the situation in Galway and the issues there. TDs from all over the country are like broken records talking about it. Limerick beats Banagher. Limerick is unbelievable, with the blackguarding going on with the public. As I said, we cannot do 15-minute cataract operations here. We cannot get appointments with our GPs for up to two weeks. People cannot even get a GP to take on new patients. That is happening all over Tipperary and the country. Our Caredoc services go unanswered as they cannot cope with the demand, while our hospitals tell people to stay away and attend their doctors.

I regularly hear that on Tipp FM about St. Joseph's hospital in Clonmel. They want to change the name to Tipperary University Hospital, having changed it twice already, from South Tipperary General Hospital. We rushed to change the name and do fol-dol and things like that. Changing the name does not make any services better. The money that has been wasted in changing names to South Tipperary General Hospital and now University Hospital Tipperary is significant. People might not think it, but every piece of paper and every item has to be changed. Changing the name and sticking the university tag on it does not say everything. We have a good service in Clonmel, with Professor Peter Murchan and his team of consultants, as well as Professor Paul O'Regan, when he was there, and many others. We had a 30-bed extension that we fought for. We now have St. Michael's, which was robbed from us by both Fianna Fáil and Fine Gael, and left abandoned for the past ten years, but now it is finally a step-down unit from St. Joseph's hospital, also in Clonmel, which I will keep calling the hospital where all my children were born, not the fancy university names.

Where are people to go when they have no option but the emergency department? They are left for hours and days, in some cases on a trolley. Most horrific of all, patients have been found dead hours after their passing in one of the hospitals. The Minister of State knows where I am talking about in Limerick, which serves my constituency. Other young lives have been lost in the most shocking incidents. How can we stand over or condone that? If a war was going on or something, we could say that could happen, but in a so-called civilised, democratic country, it is not acceptable. Our elderly, while approved for home help, cannot get any because there is no one to do the work. The HSE is happy to approve the hours, happy in the knowledge that it has ticked the box, yet the elderly are living at home, alone, and have no services. Our nursing homes are underfunded so much that many our choosing to care for loved ones at home. Where are our elderly patients going to get care? I ask that question in all honesty. It is not fair to have them, in their twilight years, worrying and suffering. The battle that is going on in Limerick at the moment is despicable. I could go on about this but unfortunately do not have enough time to talk about the failures of our health system.

Irish citizens are currently not assured of access to healthcare, at least not in a timely fashion or in a manner that represents the dignity and value of citizens of this country. We are failing them. Unless there is radical change within our health services, we will continue to fail them.

Going back to University Hospital Limerick, it is appalling. The closure of Nenagh, St. John's and indeed Ennis emergency departments was predicated on the fact that we would have a certain number of beds in Limerick. We never got those beds in Limerick, so there will be bedlam there. When that happened, we asked to reopen Nenagh, St. John's and Ennis, but to no avail. We have seen appalling mismanagement in UHL. I do not get too many cases because I am farthest away from it, but it is just shocking. Councillor Séamie Morris and others are doing Trojan work, as are Dr. Conor Reidy and his team, to try to highlight this issue. Then someone decided to have HIQA force St. Conlon's to close down the home in Nenagh for elderly care and respite because of standards. A new St. Conlon's has been built, at a cost of €50 million. It is state-of-the-art. The staff, patients and families were looking forward to and ready to move on. The powers that be have said that they are going to use it as a step-down for UHL.

HIQA condemned the St. Conlon's building but, hey presto, now a senior official in the HSE, whose name I called out here last week, said not to mind HIQA, because it will do what the HSE tells it. What confidence does that give anyone in a nursing home that is supposed to be governed by HIQA? None whatsoever, when a HSE official could say not to mind HIQA because it will do what the HSE tells it. The HSE will now allow patients to stay in an unsafe building. It was unsafe three years ago and is currently unsafe. Now they will be left again because senior officials have decided that they can do it. What is the point in having an office for HIQA, with a CEO and a whole plethora of people, when we have a brass plate on the window that states they are useless, toothless and fruitless and can be cast aside by senior health officials? It is not acceptable.

Mo fhocal scoir, it is a continual shame that the Government would close St. Brigid's in Carrick-on-Suir so unceremoniously. Three hospital suites were provided for by the people. The Government has continued not to listen to the people, meet the people or engage with the people. They are good people, staff and management. The loved ones of many people who died there were also born there. There have been generations of people. It is a lovely district hospital. It was seconded for Covid and never used, then closed down. It was good enough to be used for Covid, yet the Government decided it was not good enough. We have got no answers. The hospital action committee will come up to the Joint Committee on Public Petitions and the Ombudsmen. We have no answers and no accountability whatsoever. There is no accountability from the Minister of State, who took the decision to close it, or phoned me to tell me that she was closing it. It was in her own backyard and I could not believe it. People came in from Portlaw in that part of Waterford, where the Minister of State is from, and south Kilkenny and Tipperary. The beds have not been replaced. Worse than that, the funding that people collected in donation boxes at wakes to support the hospice, fundraisers and many other areas has not been returned to the committee or the people. Shame on you.

Jackie Cahill (Tipperary, Fianna Fail)
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I commend the excellent work that is being done by our front-line workers in all hospitals and the advancements that we have made in cancer and cardiac treatment, among others. Our hospitals give a first-class service to our population and our front-line workers do great work.

I had occasion to go to Nenagh Hospital last Monday morning. Thankfully, it was only to the minor injuries department. I got a kick from a cow on Sunday evening and my knee was extremely sore. The professionalism and speed with which I was X-rayed and treated shows that Nenagh Hospital is working very efficiently. It could be used more to help UHL. We should look at building a modular unit there to provide permanent step-down beds for UHL. That would help greatly to ease the pressure on UHL in the future. The medical assessment unit in Nenagh that was opened in recent years is working very efficiently and is now operating at full capacity.

I want to mention the proposed changes to the fair deal package in the Bill. It would be very remiss of me not to congratulate my party colleague, the Minister of State, Deputy Butler, on the great work she has done on the fair deal scheme. As a rural TD, this is something I have been seeking for many years. It has long been promised and there were many false dawns regarding the fair deal scheme. Thankfully, it is up and running now. It is hugely important that we have the three-year cap on assets for family farms and businesses.

As a country, farm ownership and land ownership in Ireland is something that is very much in our psyche. The love of the land may be due to how hard we had to fight to get ownership of it after 800 years of occupation by our neighbours, the UK. The attachment to land is ingrained. There are many cases where elderly landowners hold on to ownership of the land to their very last breath, which is their right as they own it. I commend the Minister of State on broadening the scope of the fair deal scheme in respect of successors. I will table an amendment to broaden eligibility even further. Some elderly people are the last of their generation, so they do not have first cousins and they might not even have grandnephews or great-grandnephews. It could be a first cousin once removed or a second cousin who would inherit the land. The purpose of the fair deal scheme was to ensure that the farm would stay in family ownership and would be run by that family going forward. As long as we meet those criteria, I strongly urge the Minister of State to broaden the scope of the Bill. I hope she will look favourably on the amendment I will table and broaden the scope of what can be termed a "successor".

The statistics from the Department of Agriculture, Food and the Marine show that many landowners are elderly. They are in the 70 years plus category and do not have immediate successors. In order for a family farm to continue operating, it is absolutely essential that we broaden the scope of successors in this Bill. Land prices have spiralled in the past 12 to 18 months so the fair deal scheme has never been more important. The reality is that without the three-year cap on the scheme, and allowing an eligible successor to qualify for the fair deal, farms would have to be sold to pay the nursing home bills. We did have doubts about the fair deal scheme for a long time. It is hard to comprehend how families managed to keep the farm together and meet the bills that arose.

While a family farm is worth a lot of money, it is only a vehicle to make a living. There is a saying that you live in poverty and you die a millionaire when you have a farm. That very much rings true today given the very strong prices being paid for farmland. The reality is that a farm is just a vehicle to allow someone to make a living. We all want to pass it on to the next generation and to see the next generation working the land. We hope we can pass it on in a better state than we got it. We also hope the next generation will have the same vision and ambition and be able to pass it on again.

I very much welcome the amendments the Minister of State is bringing forward in the Bill. I will table an amendment to broaden the scope of who can be designated as a successor. That can be fully justified as it would not weaken the concept of the fair deal in any way. The Minister of State has addressed many issues where we ran into problems with people qualifying for the fair deal scheme in cases where land was rented for a period before a succession was put in place. There have been difficulties but she has been very forthcoming in trying to find solutions to all problems where it was clear that the family wanted to keep ownership of the farm and to have one of their own farming the land going forward.

I am delighted to get the opportunity to speak on the Bill. I will table an amendment to broaden the scope of who can qualify as a successor so that we can ensure a family farm stays within family ownership, as long as we can show a direct connection to the owner of the land.

Mark Ward (Dublin Mid West, Sinn Fein)
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The Bill is timely and relevant to HIQA and the HSE. As the Minister of State will be aware, I previously raised the issue of elderly residents being moved from their homes in the Willow and Sycamore units in Cherry Orchard Hospital. To my knowledge, 33 residents have been moved so far and 16 remain in the hospital. Sadly, 19 of these families have since been bereaved. I raise this issue again in the hope that I will receive some answers. In the case of Cherry Orchard, the Minister previously said that it was the recommendation of HIQA to move residents. I have spoken with the families of those affected in the hospital and they told me they have conflicting evidence to suggest that the HSE made this decision, not HIQA. It seems like the tail is wagging the dog here. Yesterday, in response to my colleague, Deputy Patricia Ryan, the Minister said a HIQA inspection identified concerns about the flooring in both the Sycamore and Willow units of the hospital.

I previously tabled a parliamentary question to which I only got a response two days ago. The question was to ask the Minister for Health to outline whether the decision to move residents from the Willow and Sycamore units of Cherry Orchard was a recommendation from HIQA or the HSE. The first line of the response is that it was a HSE decision to temporarily close the units. Who made the decision to move these patients and to close the units? Was it the HSE or HIQA? Did the HSE make the managerial decision to close these units? Were other options explored by the HSE? Could work be carried out in one unit at a time while moving residents to other parts of the campus? Could the remaining residents be kept on site in Cherry Orchard Hospital in the completed safe rooms within the Willow East building? Families deserve answers. I have asked several times that the Minister of State would meet with the families but so far this has not happened. I again ask her to meet with the families.

In November last year, 68 residents and their families were told that residents would have to be moved out of their homes. Information I received from the HSE in November highlighted that there were structural problems in the units. However, I received a different response from the HSE on 14 February stating there were no significant structural problems and that only remedial works needed to be carried out. As I said previously, something does not add up here. This is the second piece of contradictory information I have received from the HSE. I again ask if there were structural problems in the units. Were they significant enough to close the units and force residents out? Who made the decision? Was it the HSE or HIQA? Will the Minister of State agree to meet with the families? The residents, families, loved ones and staff all need clarification.

Thomas Pringle (Donegal, Independent)
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I am grateful for the opportunity to speak on the Bill.

Although I completely disagree with the overall model of care for nursing homes and residential homes for people with disabilities in Ireland, I recognise that this legislation is important in the context of the current model that we have in place.

The recent significant increase in the number of nursing homes in private ownership is a worrying trend. We are seeing more private beds and fewer publicly funded ones every year. In addition, there has been a move to much larger providers, with many provider groups taking over the operation of nursing homes. These providers are mainly financed by international private equity and they run nursing homes for profit. This brings with it many issues. I strongly disagree with the provision of any sort of care for profit. The State should be obliged to provide care for those who need it. We should not allow international private companies to come here and profit from providing what is a necessary care service.

These providers are also given public money through the nursing home support scheme. If we are to put money into anything, it should be public beds and a publicly funded model. All nursing homes and residential homes for people with a disability should be funded and provided for by the State, not for profit. As a recent value-of-money review of the nursing home support scheme stated: "As governments become more dependent on large nursing home chains for services, they are less able to terminate contracts, remove residents from poorly performing nursing homes, ensure that standards are maintained, and control the costs of care." It makes one wonder what the point of government is at all if it cannot manage any of those things.

It has been made clear that we need to move away from this dependency on large nursing home chains and ensure the direct, public provision of nursing home care. The Minister of State, Deputy Butler, should, as a matter of urgency, prioritise this and the recent increase in the number of smaller nursing homes closing. Such nursing homes have a greater connection with the communities they serve. They feel for the people they care for who are not viewed as profit centres or sources of cash. That should be the priority.

HIQA’s Overview Report: Monitoring and Regulation of Older Persons Services in 2022 has shown that while the closures have occurred across the country, rural areas have been most impacted. That is because profit is harder to make in rural areas. You cannot make money out of people, which is what this is all about. The whole system seems to be about making money. Data on closures show the disproportionate impact closures are having on some counties, especially in the west. The report shows that in Donegal alone, there was a decrease of 43 beds in 2022. When nursing homes in communities close, there is a significant impact on the residents who live in the centre, their loved ones and those who are in the process of making the decision to move to a long-term care facility.

The report also showed that private providers owned and operated 77% of designated centres in Ireland, accounting for 81% of nursing home beds. The HSE only owned 20% of nursing homes and 16% of beds. This needs to be addressed, preferably by providing fully funded HSE-owned nursing homes. At the very least, we must ensure that more than half of the designated centres in Ireland are HSE-owned and we no longer depend so much on large international providers.

As I said, I fully disagree with the current model. However, I broadly support this legislation in the current context. What the Bill does not address, and what we need to provide, is intermediate care. Most of the patients in nursing homes should not be in those homes. They are too well to be in them but because there is nowhere else for them to go, that is where they are put. We should have sheltered accommodation in rural areas. There is an example of sheltered housing for rural areas in Ardara in Donegal. That is the kind of model we should be using and encouraging but there are huge difficulties with trying to get somebody to listen and look at what needs to be done. That is a real problem. We could do an awful lot to improve people's lives by making sheltered care available around the whole country.

Section 13 is particularly important as it seeks to provide a clear legal basis for the chief inspector to enter and inspect a premises which is not registered with HIQA. The fact that this is not explicitly provided for in current legislation is concerning. Inspectors should be able to enter and inspect premises where they have reasonable grounds to believe that the business of a designated centre is being carried out there and the premises is not registered with HIQA.

The Bill also provides that the chief inspector will have the power to issue a compliance notice that would set out the action the provider needs to take to bring it back into compliance and a date for the provider to achieve this. Following this, it would be an offence for the provider not to comply with a compliance notice. This is a positive and important step, especially given that there have been examples of compliance issues in nursing homes and residential homes for people with disabilities in the past. For example, the handling of the Brandon report has shown us the importance of raising issues and, unfortunately, the extent that certain people within the HSE, at all levels, locally, regionally and nationally, are willing to go to shut down and cover up some issues. HIQA also has a responsibility in relation to the handling of the Brandon report because it was aware of issues, did not do anything about them and did not raise those issues. That calls into question the idea of HIQA being the so-called independent model that will look after everything and how we can have faith in that organisation as well. That is very important because whatever system we put in place, it has to be accountable and transparent. Every citizen in this country should be able to look at it to see if and what is working and what it is doing. That is the only way that people can be protected and know the system is working on their behalf, not on behalf of the for-profit models.

When will the review commissioned by the Minister of State, Deputy Rabbitte, into the Brandon case be published given that it was due to be published last year? What has happened in relation to it? The Minister of State, Deputy Butler, is not responsible for that but I want to put that question on the record because it is important. It goes to the overall compliance with HIQA and what HIQA will do in the future based on this legislation.

Catherine Connolly (Galway West, Independent)
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I remind Members and Ministers we will be moving straight on to the Topical Issues straight after this business. I am giving Members a forewarning.

Mary Butler (Waterford, Fianna Fail)
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I thank Members for their contributions to the debate on the Bill. I look forward to their support as the Bill is considered further on Committee Stage. I note 95% of all those who spoke, even though they raised issues, were supportive of the legislation and I thank them all for that.

The Bill provides for a number of pertinent and timely amendments to the Health Act 2007 and the Nursing Home Support Scheme Act 2009. First, the amendments to the Health Act will bolster the existing regulatory framework for residential care centres regulated under the Act, updating the chief inspector's current powers and amending current provisions to ensure they provide the optimal safeguards for the people living in these centres. The Department of Health has worked closely with the chief inspector in developing these provisions to ensure they are effective and operationally valid. As Minister of State with responsibility for mental health and older people, I would add that these new provisions address several key recommendations in the Covid-19 nursing homes expert panel report, which called for the enhancement and modernisation of powers and requirements within the regulatory framework governing nursing homes and the establishment of mandatory reporting to HIQA of key operational data by nursing homes to support service planning and policy development. Second, through amendments to the Nursing Home Support Scheme Act 2009, the fair deal, it will widen the definition of those eligible to be considered as a family successor to a family farm or productive business assets.

While overall there is good adherence to the regulations across our care services, in a minority of cases compliance is poor, with a direct impact on the standard of care on residents. In these cases, it is absolutely necessary that effective enforcement mechanisms are in place to address these gaps. The specific enforcement measures include compliance notices and the power for the chief inspector to enter and inspect premises where she suspects the business of a designated centre is being carried on while unregistered. Additional enforcement measures include the reduction in timelines for service providers to make representations and lodge an appeal of a decision of the chief inspector to the District Court, with regard to a registration of a designated centre. Cumulatively, these measures will provide for more timely and proportionate interventions where there is a breach of the regulations, thereby providing the chief inspector with further mechanisms to ensure that the current protections for residents, as required under regulations, are adhered to and upheld.

The systematic collection of key data across the sector is essential to ensure effective national policy is in place and supported by targeted service planning. As Deputies will be aware, given the majority of nursing homes are under private ownership, there is no system in place to gather this necessary data. It is important to underline that any data collected will not be at an individual level and robust safeguards are in place to ensure that any data that may lead to the identification of an individual will not be shared or published.

The Bill also provides for an important change to the definition of those eligible to be considered as a family successor to a family farm or productive business assets under the nursing homes support scheme. This amendment is being sought to extend the definition of those eligible to be considered as a family successor to include cousins, great-nephews and great-nieces, and great-grandchildren as per a Government decision of September 2023.

The Bill reads as "first cousins", which is problematic. Deputy Cahill indicated he would submit an amendment. I do not want the Bill to be restricted to first cousins because a first cousin would potentially be around the same age as a bachelor farmer or bachelorette. It is, therefore, very important that the Bill covers cousins, second cousins and third cousins. There are also once-removed cousins. I do not want to disallow anyone, including an individual with no other family member. We came across three instances where that was the case. We will work with officials to get that over the line with Deputies' support. The rationale is to allow farmers and business owners who choose a family successor, who may be available in a limited or non-existent way under current legislation, to avail of the three-year cap. This amendment satisfies the policy objective of safeguarding the viability of a farm or business and allows equity in accessing the fair deal scheme.

I will speak about some other significant and related developments. I am pleased to announce that I have secured Cabinet approval to publish the general scheme of the health (amendment) (licensing of professional home support providers) Bill 2024, which will introduce a new licensing framework for home support providers. This means that service users who receive home care in their own home can be assured of the same minimum standard of care wherever they live. This framework will be supported by the national quality standard, which will be developed by HIQA. HIQA’s chief inspector will be responsible for independent monitoring and assessing compliance of registered home support providers.

It is also worth noting that the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023 provides a legislative framework for a number of important patient safety issues, including the mandatory open disclosure of a list of specified, serious, patient safety incidents that must be disclosed to the patient and-or their family, and the expansion of HIQA’s remit into private hospital services. Section 64 deals with investigations by HIQA where the agency believes there is a serious risk to the health or welfare of people receiving a particular service. The Act was passed by both Houses of the Oireachtas and signed into law by the President in May of last year. Prior to commencement of the Act, a number of preparatory steps are required. These are currently being progressed and significant multi-stakeholder engagement has been taking place across the health system. Work with key stakeholders, including the HSE, the State Claims Agency, HIQA and the Mental Health Commission, is nearly complete. Once these steps have been completed, the intention is to commence the Act at the earliest possible date. I know many Members will welcome that.

A number of Deputies drew attention to the important topic of adult safeguarding, which is a key objective for me as Minister of State. The development of a new national policy for the health and social care sector is now at an advanced stage of development. In January, I published my Department's policy proposals on adult safeguarding in the health and social care sector for a public consultation which closed last month. At a wider cross-sectoral level, the Law Reform Commission has recently published a comprehensive and wide-ranging report, A Regulatory Framework for Adult Safeguarding, together with draft criminal and civil legislation. The Department of Health looks forward to working in partnership with all relevant Departments in analysing and considering the commission's recommendations.

On patient advocacy, I have ensured the continued expansion of the service, which is a national service commissioned and funded by the Department of Health. The Patient Advocacy Service provides a free and independent national service, which helps people using healthcare services to make a formal complaint regarding the care they have received. The Patient Advocacy Service was extended to private nursing homes from 1 November 2022. Legislation was amended to support this roll-out and streamline complaints in December 2022. That service was previously only available in the public sector but has now been rolled out across the private and voluntary sectors.

As Deputies are aware, significant work has taken place on the recommendations of the strategic workforce advisory group on home carers and nursing home healthcare assistants. I reassure them that HSE home support staff recruitment is exempt from the current employment control measures, where the posts are to facilitate discharge from hospital. The HSE has also encouraged its chief officers, where appropriate, to consider increasing the hours of current home support staff who may have additional capacity. If they are contracted for 39 hours, for example, but may only be working 18, 20 or 22 hours, they are entitled to work up to their full contract. All home care offices have been written to in the past few weeks. It is very important that if people have capacity to deliver more home care within the HSE, they will be allowed do so within their contract. It is encouraging that recruitment continues among private and voluntary providers who deliver approximately 60% of home support.

Notwithstanding many of these challenges, I note that Ireland has the highest life expectancy in the EU, as determined by the World Health Organization. We were also formally recognised as the first age-friendly country in the world in 2019. These are remarkable achievements and are to be celebrated, but there is a lot more to be done. Once again, I thank Deputies for their contributions on the introduction of the Bill to the House. I look forward to working with colleagues across the House to progress this important legislation through the Dáil as quickly as possible. I commend the Bill to the House.