Brian Stanley (Laois, Independent)
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This matter relates to nursing homes and the lack of enforcement of standards. Last week, we witnessed shocking scenes in the Residence nursing home in Portlaoise and the Beneavin nursing home in Dublin. I am sure the Minister of State is aware that there are other cases as well. We saw was: a shocking level of neglect; abusive behaviour; residents told to soil on incontinence pads; elderly, vulnerable residents left lying in urine for hours at night, calling for help but getting none; rough handling; shortages of sanitary goods and other basic items; and no assistance with eating, which is a major issue. There are 15 or 20 minutes allocated to getting people fed. Some of these people cannot feed themselves, so the food is not eaten. Then it is taken away as if they are not hungry that day, when they might be very hungry.

A former carer in Portlaoise nursing home has informed us that the RTÉ programme only touched the surface. She described at length what she saw during her time working in the nursing home over a number of years and outlined the appalling practices there. There are some shocking examples, and these occurred before anything came out on RTÉ. An elderly mother was looking to have her incontinence pad changed and, despite repeated requests, it did not happen. Her family eventually took her out of there. A man with Alzheimer's from another town in the county was recognised by a former neighbour walking around the town - he did not even know where he was - and contacted one of his family members. They got him back to the nursing home. He was wandering around and nobody had missed him. A plan was agreed and corrective measures were to be taken, but these were not implemented.

The protected disclosure was about a third nursing home. It was not about those two nursing homes at all. The person making the protected disclosure had to go to RTÉ because nothing was done for two years. The shortage of staff was not addressed. The abuse and neglect continued despite families bringing it to the attention of management and being assured that improvement plans would be put in place and it would be addressed. This did not happen.

Worst of all, the nursing home continued taking admissions despite being banned by HIQA. Where are the sanctions? There are none. HIQA has failed miserably. I had faith in HIQA up to about ten days ago. I have no faith in it now. I have lost all confidence in its ability to monitor care in nursing homes and enforce regulations and rules. Will we have a Garda investigation into some of the criminal activity we saw? Has HIQA issued financial penalties? Has it deregistered any of the nursing homes owned by these large companies. I understand that the one in this case owns 27 homes.

I met representatives from the Irish nursing home alliance today. They outlined that 77 small independent nursing homes have closed in the past five years. Most of this happened due to strict demands. HIQA holds such homes to the letter of the law in order to make sure they are closed. Ballard Lodge in Portlaoise, which was providing excellent care - I never heard a complaint against it - closed recently. That is one of the most recent casualties of HIQA standards. These smaller homes are being held to the standards. Abbeyleix public nursing home was almost closed 13 years ago because of HIQA demands, but a large public campaign that and others were involved in stopped it from happening. Thank God we kept it there. Why does it appear there is a more lackadaisical approach to the larger multiples such as that which we saw last week on the television? Have they got more clout? I do not know.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the Deputy for raising this very important issue. We were all shocked and appalled by what we saw on the "RTÉ Investigates" programme last week. I appreciate the opportunity to comment on the matter. I especially recognise how incredibly difficult it has been for the residents of the Residence in Portlaoise and Beneavin Manor and their families. We heard that first hand from the family of Audeon Guy this evening on "Prime Time".

I want to make it clear that poor care, neglect and any form of abuse of individuals residing in long-term residential care centres is wholly unacceptable. The highest standards of care and dignity must be always upheld, without exception. Every nursing home resident deserves the highest standard of care at all times. To achieve this, registered providers must adequately support their staff. Having effective governance and management arrangements in place ensures that staff are equipped to deliver person-centred care to residents.

The distressing footage aired during the "RTÉ Investigates" programme highlighted serious issues of non-compliance within these facilities. The welfare of residents and their families remains a paramount concern for me. Action is being taken to address these failures and strengthen oversight to ensure the protection and well-being of all individuals in these nursing homes.

First, I fully expect HIQA and the office of the chief inspector to utilise all powers available to them to ensure rigorous oversight and accountability in nursing home care. HIQA's chief inspector has confirmed their continuous intensive engagements with the two nursing homes concerned and has committed to providing me with an update on their progress by the end of this week. I assure the Deputy that my Department and I are monitoring developments closely, with both these nursing homes and the welfare of residents remaining my highest priority.

Second, I have formally requested an overview of the nursing home operators owned by Emeis. The chief inspector has committed to furnishing an interim report to me by the end of this week and a full report by the end of next week, providing an overview of regulatory history, including but not limited to regulatory compliance, escalating enforcement actions and any additional conditions of registration.

Third, the directors of nursing from both local HSE community support teams have been on site at the two nursing homes in question. Additionally, local safeguarding and protection teams are actively reviewing all safeguarding concerns raised in relation to these facilities.

I and Department of Health officials met with representative bodies and stakeholders from the nursing home sector earlier today. The engagements were constructive, with an immediate focus on delivering the highest quality of care to residents of nursing homes in Ireland.

On the safeguarding points the Deputy made and on adult safeguarding in the sector more generally, the Government is fully committed to strengthening existing protections. We will publish a national adult safeguarding policy for the health and social care sector shortly. The policy will commit to the development of adult safeguarding legislation for the sector 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 Government has included a health (adult safeguarding) Bill in its current legislative programme to facilitate this. It is recognised that this will be an important further development in preventing abuse and protecting vulnerable adults from abuse.

What happened in the two nursing homes featured in the "RTÉ Investigates" programme was appalling. It was sheer neglect and abuse of older people. This is something that I, the Department and the Government take very seriously. It is something I want to ensure, through the process I have outlined, never happens again.

Brian Stanley (Laois, Independent)
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I thank the Minister of State. I would like an explanation for a whistleblower having, after two years of inaction on the part of the chief inspector and HIQA, to go to the media to highlight all of this. Surely that is a scandalous situation. They say you judge a society by how it treats its weakest. The weakest are the elderly and the very young - infant children. The Minister of State said the chief inspector will carry out a review. The chief inspector has failed in relation to three nursing homes, and possibly many more. My understanding is the chief inspector's position, legally, is supposed to be separate from the inspections carried out by HIQA operatives, yet HIQA staff must have their reports approved by the chief inspector.

HIQA does the report but it is filtered through the chief inspector despite the fact that there is supposed to be separation. Why does the chief inspector have to approve all of these reports? The problem is that this rests on one person. One person's determination or judgment will decide what will or will not happen. HIQA cannot issue the report without that approval.

When will unannounced inspections be carried out? They must be thorough and strict inspections. When will there be effective sanctions? What about deregistration and financial penalties? Are there financial penalties? I do not know. Perhaps the Minister of State can tell me whether there are penalties in law. When will this important legislation - the 2017 Bill on safeguarding the elderly - be enacted? It has been sitting there for eight years. We are all to blame for that but primarily the Government is to blame because it is a Government Bill. I would like to see it progressed. I understand that the officials have drafted the Bill but we have not seen it in the House. We need to do this urgently.

Kieran O'Donnell (Limerick City, Fine Gael)
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There is a commitment in the programme for Government to bring forward an adult safeguarding policy for the health and social care sector. I expect the issue will be brought to the Cabinet before the summer recess. Following that, we will be looking for approval to progress a health and adult safeguarding Bill, which is in the current legislative programme. It is a matter of absolute priority.

I am on record as saying that I would like to see inspections taking place more quickly and timeframes for protected disclosures. The Deputy will appreciate that I want to work within a process. Immediately after the two nursing homes were named by RTÉ, I met representatives of HIQA and requested two things. The first was that HIQA would engage intensively with the nursing homes. It committed to doing that. The second was that it would provide a report on the Emeis group and all its nursing homes. I asked for an overview of all its nursing homes and its regulatory history, including but not limited to regulatory compliance, escalating enforcement actions and any additional conditions of registration. I expect to receive a report with an update on the two nursing homes by the end of this week. I also expect an interim report in respect of the Emeis group by the end of this week and a more substantive report on it - the full report - by the end of next week.

This is all about older people in nursing homes. I want them to have safe environments. We all have elderly relatives. It is something I feel strongly and passionately about.