Malcolm Byrne (Wicklow-Wexford, Fianna Fail)
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I thank the Minister of State for being here. He is very much aware of the "RTÉ Investigates" programme and the work that was done by Aoife Hegarty and her team. It was an example of quality public service broadcasting. I know the Minister of State, like me and so many others, was appalled by what he saw on his screen. I know he wants to take action on foot of that. The Taoiseach said that when HIQA carries out particular actions, it should be in a position to press the button that will require the closure of certain nursing homes if they are not up to standard. I welcome that commitment. Unless the ultimate deterrent can be applied, that small minority which are flouting the rules will not respond.

It is important to note there are many quality nursing homes and centres that provide for the elderly within our communities and they are equally appalled by what has happened. In my own community in north Wexford, many of those who provide quality care were disgusted by what they saw on their screens. It is as important for those who are quality providers of care for the elderly that the rogue element within the sector is stamped out.

As the Minister of State knows, the bigger challenge is that we are all getting older and we are all living longer. Over the next 20 years, the population aged between 65-84 is projected to increase by 65% and the population of those aged 85 and over will double. The fact that life expectancy in Ireland is now hitting 83 years of age is a major success. Those who regularly criticise aspects of the State should recognise that the fact we now have one of the best life expectancies of anywhere in the world is something we should be proud of as a society. However, we have to ensure older people get to live in dignity in later life and we also need to ensure that, insofar as possible, they can be healthy later on in life.

While it is important for us to talk about nursing homes and the sanction that needs to be levied against those errant nursing homes, we should also celebrate those who do a lot of good work in the sector. In particular, we should recognise those with qualifications in the sector. There is a broader debate around older people within society, though, and around how we design our societies to be able to ensure that older people can take part and be involved. We can learn from societies that have faced this challenge, such as Japan and Italy. I do not think we will be going to those extremes just yet but certainly their experiences of having larger older populations are very important to learn from.

An issue I want to refer to is the importance of trying to ensure we keep people healthy. If we can keep people out of hospitals and out of nursing homes, that is the best thing we can do. Part of that is about care in the community, but it is also about encouraging a lifestyle of health and fitness right through until older age. Once you get into your 30s, 40s or 50s, when you tend to become less active, it is critically important to keep up some level of physical activity in those stages of your life. The Minister of State will be aware that in budget 2025 the then Minister for Finance, Deputy Chambers, announced there would be a review around the concept of tax relief for gym membership, but also other incentives for people to be involved to ensure they remain healthy into older age. That is something I strongly support. There is a lot of wonderful work being done by the Active Ageing programme and others about keeping older people active within our communities. Too often, there is a danger - I say this respectfully - that we do not have a Department of Health but, rather, a Department of illness and sickness, and we do not spend a sufficient amount of time focusing on positive health promotion about ensuring how everybody, but older people in particular, can live independently in the community and live healthy lives.

I hope the Minister of State, in his response, can broaden this debate. Like so many others, I share the outrage at what we saw on the "RTÉ Investigates" programme. We cannot allow it to happen again and action needs to be taken against that minority.

David Cullinane (Waterford, Sinn Fein)
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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.

Kieran O'Donnell (Limerick City, Fine Gael)
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I welcome that.

Brian Stanley (Laois, Independent)
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I welcome this opportunity to address the issue of nursing homes. I am aware the Minister of State has taken an interest in it but there are major issues to be addressed. In this regard, I must raise the over-reliance on private nursing homes with him. It has increased. That 80% of nursing homes are now private has skewed things and left us at the mercy of the private sector. Unfortunately, some in the sector will abuse their position. We have seen terrifying examples of this in recent weeks.

The incidents of neglect and abuse have been well aired and I am not going to go over them again. I went over them previously in the Chamber. Despite the improvement plans and commitments given to both HIQA and the families, particularly regarding the residents in Portlaoise, they were not followed through on. The company in question breached the admission ban and continued to admit people after February even though it was told by HIQA not to. The time for change is long overdue.

I welcome the fact the issues at The Residence have been referred to An Garda Síochána. In this regard, HIQA has questions to answer. Whistleblowers' complaints were not acted on for two years. Not until we saw the RTÉ exposé did we start to become acquainted with these issues. There were 40 notifications of alleged abuse to HIQA in 18 months. What happened with those 40 notifications? What action was taken on them? There seems to have been very little. There was a five-month gap between some of the inspections in The Residence despite many problems piling up. There was no action taken on that. It is clear that improvement plans agreed with HIQA and the HSE were not acted on. That is simply not good enough while we are depending on these nursing homes. I met HIQA representatives on the issue of possible penalties. HIQA can halt admissions, prosecute and deregister, and it has a complaints system. Ultimately, cases can be filed with An Garda Síochána, as has happened in this case.

There is a report today on public nursing homes, one being in Mountmellick, County Laois. It is an old nursing home with a new wing being built onto it. If the Minister of State has any influence, he should push this on quicker. We need to get it opened. The nursing home received a glowing report. There were a few minor points here and there – nowhere will ever be perfect – but, overall, I could describe the report only as “glowing”. One resident told HIQA that there were so many activities that they had not time to get bored, and that people were very happy and content.

We must try to reduce dependency on nursing homes. Some people will have to go to a nursing home at some point, as most of us accept, although we hope it will never happen to us. Where we can at all support people at home, we must do it.

Portlaoise meals on wheels is starting up again. We have had no meals on wheels in Portlaoise for four years. Again, if the Minister of State has any influence, he should note the service will need funding. We have secured a kitchen and I have some involvement with the project. We need the service up and running and more supports for meals on wheels.

Kieran O'Donnell (Limerick City, Fine Gael)
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The Deputy should write to me about that.

Brian Stanley (Laois, Independent)
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One proper meal per day can make a major difference.

There should be more home help staff and more flexibility in what they can do. There should be more public health nurses, who are fundamental in keeping people in their homes.

Deputy O'Donnell, as Minister of State, will agree that loneliness is killing people. This is not something the Government can sort on its own. Whatever we can do through voluntary organisations and society as a whole, we should do it. We should send out the message that we need people to visit their elderly neighbours. I used to do it as a young person going to school. My mother used to send me to visit old people on my way home from school. If they needed kindling brought in for the fire, for example, I brought it in. It was just a matter of chatting to them for a few minutes.

Paul Murphy (Dublin South West, Solidarity)
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I found the “RTÉ Investigates” programme horrifying, obviously, and very difficult to watch. It was clear that the older people were not being treated as human beings, with decency, dignity and respect. Instead, many were being treated simply as a burden – a burden for whom there were not enough gloves or incontinence pads. They were treated like sacks of meat thrown on the chair, as was the case with one man. It is clear that this is not unprecedented or really unexpected. Cost-cutting, staff shortages, elder abuse and the ripping off of vulnerable people are all inevitable when you hand over healthcare to faceless multinationals motivated only by profit.

SIPTU, ALONE and the INMO have all pointed to privatisation as being at the root of this scandal. The root is neoliberal Government policy implemented by successive Fianna Fáil and Fine Gael Governments to outsource our care of older people to multinational corporations.

In the 1980s, three quarters of nursing homes were publicly owned and operated, but now the proportion is less than a fifth. Private, for-profit operators control 74% of our nursing home beds, and just ten investment funds in Ireland control 30% of our nursing home beds.

This did not happen by accident. This is not something that unfortunately happened, that Micheál Martin and so on are very sad about. It was deliberate Government policy. As with private hospitals, the State provided private nursing homes with massive tax relief on capital expenditure and guaranteed them an income stream through Mary Harney's so-called fair deal scheme. Income for private nursing homes through the fair deal scheme has ballooned. Total funding is now over €1.2 billion a year, 80% of which goes to private nursing homes. The fees are incredible.

At The Residence in Portlaoise, fees are upwards of €1,200 a week, but not satisfied with that, the abusive, money-grabbing multinational, Emeis, which runs The Residence, has also been ripping off elderly people and their families by illegally charging extra for essentials like medication, dressings and pressure-relieving mattresses to prevent bedsores. Incontinence wear costs up to €90 extra a month. A hip protector is €60 a month. If residents go into hospital, they have to pay for their own transport plus a staff charge of up to €45 an hour. How much of that do the carers see? Maybe a third or a half, with the rest going to the largest nursing home provider in the State. Families are charged €15 a week if they want to rent a sensor that alerts them if a patient falls out of a bed or a chair. Given the gross understaffing of The Residence, it looks like they would need it.

Incredibly, there is no legal minimum staff to resident ratio for nursing homes. Presumably, the private providers lobby to keep it that way because wages are their main cost. That is why nursing home carers are among the lowest paid and most overworked workers in the country. That is how much this Government, Fianna Fáil and Fine Gael, value older people. The stock response is to say that better regulation is needed. Yes, absolutely, it is. For years, care champions and others have been screaming about this and pushing for safeguarding legislation. This scandal should force the Government to act. Ultimately, we are not just talking about a few bad apples. This neglect and abuse is endemic in a system that is for profit. We have to end the privatisation and bring it back into public ownership.

Catherine Connolly (Galway West, Independent)
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Here we go again about nursing homes. A scandal has given us cause to talk about nursing homes. All the details of that scandal have been outlined. I am not going to outline them again. It is bewildering that HIQA had a report on one of the homes, Beneavin, in November, and it was substantially compliant. That in itself is frightening. I looked to remember, because my memory is faulty, when we closed St. Francis Nursing Home in Galway. On the streets of Galway, in 2011, over a winter period, we gathered more than 20,000 signatures, begging the Health Service Executive not to close St. Francis Nursing Home. It ignored the people of Galway and the signatures, and it closed the nursing home. We managed to keep it open as a primary care centre. I am using that as an example.

Around that time, I travelled to Portlaoise too, where the HSE was closing a public nursing home in Deputy Fleming's constituency. I cannot remember what happened with that. We joined forces. That was back in 2010 and 2011, when we said the writing was on the wall with the closure of public nursing homes. That started earlier with Fianna Fáil and the Progressive Democrats' philosophy, which I have repeatedly said knew the price of everything and the value of nothing, with the mantra that private is best. Every single Government policy went to ensuring that private was best, not for care but for profit-making, and that is what happened.

I have asked a number of questions about how many private nursing homes have had to be taken over since 2020 alone. I have counted 11 in Wicklow, Kerry, Galway, Galway, Kerry, Cork and so on. The private nursing homes get into trouble and then the public system has to send in staff in Oughterard in Galway and in Galway city, into private, for-profit companies which are unaccountable. We send in staff, which is ironic because there is a nursing home in Carraroe, which I have mentioned many times, that cannot get staff, and it has 13 beds, or somewhere between ten and 15 beds at any given time, i gcroílár na Gaeltachta, and the HSE says that there are no staff. Yet, when these private companies get into trouble, we seem to be able to send in staff no problem to take them over. I am not sure if we have learned anything or what the cost has been of looking after the private companies that got into trouble. We are all in receipt of the public accounts, which I will not read out. Absolutely harrowing correspondence arises from Covid, including how many died in nursing homes and how they were treated. This is 2025 and people are still trying to get documents and appealing to us.

Let us look at the percentages. Not even 20% are in public ownership. It is much less, as we know from the Public Accounts Committee. That 20% or less includes publicly-owned nursing homes plus voluntary bodies. I think it is as low as 14% or 15%. I know Galway has an excellent reputation, with Merlin Park and the St. Francis home when it was there. I despair sometimes at the forcefulness of a lobby group and Governments that back up the market when all of the facts tell you otherwise, when we just pursue one avenue and keep reducing public ownership of nursing homes until it is nothing. If we are to learn anything from this, rather than listing the scandals, perhaps we could have a change in policy from the Government.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I welcome the opportunity to contribute to this debate. We are all quite rightly sickened with the recent "Prime Time" exposé about how certain nursing homes treated residents, the impact that has had on the families of the affected residents and also the impact that has on families who have people in nursing homes. My family has just gone through an agonising number of months, deciding whether nursing home care was the right care for my father. We arrived at that decision a number of weeks ago.

It is important that all families realise that this is not a universal problem, because there is serious worry. It is equally important that families know that when elder abuse happens and there are failings in nursing homes, there has to be accountability and there have to be consequences for the firms and individuals who perpetrated abuse in these nursing homes. There needs to be accountability for the firms which are receiving €1.2 billion in State funds per annum to support the provision of care.

In the next decade, we will see the number of people over 65 increase by 50%. I agree with the previous speaker that the State needs to move away from the privatisation of care and care homes. My experience tells me that the vast majority of people do not want to live out the end of their days in care homes. They would rather remain in their home for as long as practically possible. Funding for public services in this area has increased in the last number of years, with additional home care hours and additional daycare centres, and people have seen the benefit, but much more needs to be done. We need to remove the 16-week waiting list to be assessed for home care services. We need to ensure that people who are approved for home care hours get them seven days a week, not five days a week. If you need care on a Monday, you are going to need it on a bank holiday Monday, a Saturday or a Sunday. We need to ensure that the daycare centres are expanded regardless of their geographical location.

The previous programme for Government committed to a statutory home care package. Why is there a delay? Can the Minister of State commit to that package being introduced as a priority by this Government? HIQA was established as a response to a previous exposé of elder abuse. Why was it not established on day one with adequate powers to fine private operators which are failing abysmally in their responsibility to their residents? Can we ensure that, out of this, we will see adequate powers in place for HIQA and that HIQA will concentrate on the provision of care, not the quality of building?

Michael Cahill (Kerry, Fianna Fail)
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Since the airing of the "RTÉ Investigates" programme on national television, families feel terrified. They do not know what way to turn.

My constituency office in Killarney, County Kerry, is inundated with queries about home care. Those queries are asking what is available to families to look after their loved ones at home. Many of these would be under extreme pressure to be able to cope at home but they are turning away from private nursing homes following the recent scandal. There is no doubt about that.

Regarding sanctions, penalties, suspensions, termination of contract, what has happened in that area? As the Minister of State will know, I raised the issue of the company involved coming before the Joint Committee on Health, that I am a member of. The company should be brought in. There is no doubt about that. At the end of the day, it is ultimately responsible for what has happened in both of those homes. Both homes were in receipt of millions of euro of taxpayers' moneys. There should be accountability here. The idea of our elderly people being afraid of going into long-term care is frightening. It is a sad day and a sad reflection on our society in this day and age in 2025. The sad thing about it is that all other nursing homes are being tarnished because of this. There has to be accountability.

We have great community hospitals in Kerry. We have some of the very best. We have wonderful directors of nursing, matrons, nurses, doctors, carers, caterers, cleaners, etc., in places such as Cahirciveen Community Hospital, Valentia Island Community Hospital, St. Joseph's nursing home in Killorglin, St. Columbanus home in Killarney, and the list goes on. I plead with the Minister of State to bring about accountability here and bring those responsible before us, particularly at the Joint Committee on Health as that would be a good starting point. I do not see any reason they should be allowed to refuse. I have seen that happening at the Committee of Public Accounts recently. That is another issue I have commented on publicly already. Anyone invited in should be brought in.

Cathal Crowe (Clare, Fianna Fail)
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I welcome the opportunity to speak in these statements. Like everyone, I was appalled by what I saw on the "RTÉ Investigates" programme. The flood of emails and phone calls that came in the following day from sons and daughters of elderly people who are in nursing home care, fearing that HIQA does not have eyes correctly on the situation in many scenarios. I agree with others that it has unfairly tarnished best-practice healthcare for older people. Sometimes the reaction to these things is rightly an outpouring of anger, frustration and huge upset, but sometimes that spills over into painting all with the one brush, which is not the case.

It is important that when HIQA identifies areas of non-compliance and neglect, it uses the ultimate nuclear option to shut down some of those facilities. I know that creates other huge problems for healthcare, such as where do the residents go and how do we provide for their needs? That is the ultimate sanction HIQA has over them. It should not be a roll-over after an inspection and that it will see how they have improved the next time. It needs to use the ultimate sanction sparingly, but in scenarios like this it should have been used.

As others have said, State-provided care, or the old county homes as people call them, such as St. Joseph's in Ennis and St, Camillus's in Limerick which a lot of people in my area would go to, provide quality care. The State should be more involved. In the previous Dáil, Milford hospice in Limerick, which is a cause and a hospital close to the Minister of State's heart, my heart and the hearts of most people in the mid-west moved over to a section 38 organisation. That was transformative and incredible. It no longer has to go around shaking the biscuit tin, trying to collect money and holding fundraiser after fundraiser. It now has a direct line of funding that means it can get down to the real high quality care it provides. More of that needs to happen.

On staffing stability, as recruitment embargoes in various areas of the HSE begin to lift, there is a real fear in the voluntary not-for-profit nursing home sector that it will begin haemorrhaging some of the nurses brought in from overseas who will leave and migrate to the HSE, having gone through all the paperwork and rigamarole of bringing them in on visas and training them up to the highest standards of Irish healthcare. The Minister of State needs to have eyes on that scenario.

The Minister of State's colleague, the Minister for Health, Deputy Carroll MacNeill, has directed HIQA to look at the ESRI report when it examines the University Hospital Limerick capacity for emergency care. In light of that ESRI report, which overwhelmingly identifies the need for new hospital beds and new hospital environments, some of that data needs to be fed into nursing home care. Do we have enough nursing home beds and facilities, public and private, going forward? We already know what the answer will be. Let us see it and let it lead public policy. I wish the Minister of State well in his role during the lifetime of this Government.

Naoise Ó Cearúil (Kildare North, Fianna Fail)
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It is said a society should be judged on how it treats those who are most vulnerable. In this case, it is older people in our society. What we saw in the "RTÉ Investigates" programme was not care. It did not look like the dignity of older people had been looked after. We owe a debt of gratitude to "RTÉ Investigates" for shining a light on what happened in some settings and on the fear it is happening in others. What we saw was elder abuse. There is a natural fear in society it is happening in other locations. It is important to call out that a lot of the care settings are excellent, with excellent nurses, excellent care staff and excellent management but there are a few bad apples, which is obvious.

We have seen how Tusla has operated in the past for the betterment of protecting young children, in particular. The establishment of an independent adult-safeguarding authority is warranted. This would focus primarily on looking at the safeguarding of older people, in particular vulnerable adults. This type of authority is something that could help in protecting those most vulnerable in society; those older people in nursing homes. What I am trying to do, rather than regurgitate the problems and the anger and frustration we all feel as a collective, is try to come up with some solutions. That is one solution I am proposing.

Another solution is a national register of care concerns and complaints. This would be a publicly accessible, anonymous database of serious complaints about different care homes throughout the country. It would be administered by HIQA. In that regard, it would give families a little more insight into what is happening in various care homes and, indeed, the decision-making process around what care home they are going to send their loved one to if they do have to come to that reality. I am proposing two solutions. One is around an independent adult-safeguarding authority similar to Tusla and the second is a national register of care concerns and complaints.

The important thing here is transparency so families and those vulnerable people in care homes know what is happening and have the full knowledge of what is happening. I will liaise with the Minister of State after this to see if either of those suggestions could be progressed.

Barry Ward (Dún Laoghaire, Fine Gael)
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What we saw in the "RTÉ Investigates" programme was very upsetting. The notion that anybody entrusts the loved one in their family, who is arguably at the most vulnerable stage in their life, to a home and they are treated in the way we saw them being treated is frightening as much as it is upsetting. The reality is that I talk to people every day who are in a situation where an elderly parent or elderly relative needs the kind of care that means they have to go into a nursing home. We are asking them to put their trust in a system that is clearly deficient in terms of the safeguards and checks in place.

I have been contacted by a constituent and I want to read what she said about her father's experience, albeit in a nursing home in County Wicklow, not in my constituency, but she lives in my constituency in Dún Laoghaire. She talks about the experience that he had towards the end of his life in that nursing home. What she has reported to me is quite shocking. She and her family were frequently ignored when they raised concerns with the nursing home about their father's well-being.

He had multiple urinary tract infections that went undiagnosed and untreated, meaning he was in significant discomfort, as well as the health risks this posed. His medication was not properly administered. He suffered from bed sores that were left untreated and not dealt with and we can imagine the pain and discomfort he would be in, lying in a bed and unable to help himself. The family raised concerns with the home and were repeatedly ignored. It was not until the family initiated legal action that they were listened to and interventions were taken by the staff in the care facility. The care facility failed to ensure he received proper food and water or that he consumed it. The staff failed to engage with the family about their father's health. The care facility failed to adequately deal with the physiotherapy needs of their father as well. There were consistent patterns of neglect and a lack of care. Even in his final days, the family struggled to get palliative care and painkillers to help their father. This is just one case, one constituent who emailed me. There are others and I have just chosen this from a number of emails.

What this brings home, and I know the Minister of State is alive to this and understands it, is the seriousness of this issue. I hope everybody in this Chamber reaches the age where they will need to rely on somebody and will need to rely on the care of people, so many of whom do such great work. I know, having dealt with carers in nursing homes, that they love the care they give to the elderly. We need to make sure every one of them does that, and where they do not and where they fall short, that there are consequences and, most importantly, action.

Máire Devine (Dublin South Central, Sinn Fein)
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I know of a mammy who retrained after having children and received a healthcare assistant qualification. She was delighted to get a position in Beneavin Manor. Her delight quickly turned to despair as she witnessed horrors beyond comprehension. Patients were taken to the toilet by staff and left for hours only to die there, and the times and manner of death were brushed over for families. There were many instances of vulnerable patients physically fighting among each other and staff were not trained in de-escalation. Sexual assaults between residents were never reported or addressed and, even more disturbing, staff members were caught engaging in sexual activity in a resident's room. Many staff members took drugs during shifts and even offered her some. Patients were underfed and would be starving and crying.

When she spoke out, management was very dismissive and considered her the enemy within. Her breaking point was when a gentleman was prematurely and unnecessarily placed in palliative care. This happened to several patients. Staff, during conversations with patients' families, pushed palliative care as a preferable option and, of course, family members listened to the experts.

HIQA was notified on multiple occasions about specific abuses, the lack of supplies and understaffing resulting in residents' mistreatment but did not act. Everything went swimmingly when HIQA visited, but the chaotic and neglectful norm would return. She left this job feeling very distressed and traumatised. She believes all three campuses should be shut down.

Everybody needs someone who has his or her back. There is no heart or compassion in this nursing home. It is still about the bottom line. We will all grow old, and this former staff member hopes divine justice will prevail for the many who passed away during her time in the care facility. We need to do something.

Denise Mitchell (Dublin Bay North, Sinn Fein)
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I, like so many others who watched that "Prime Time" programme, found it very disturbing and upsetting. Our older citizens who are in nursing homes deserve to be treated with dignity and respect. Frankly, there is no excuse for what we witnessed on our television screens. I cannot imagine the upset this programme generated for families across this State, with people wondering if their relative or friend was treated the very same way once visiting time was over.

I acknowledge the whistleblowers who came forward and reported their concerns. They should be commended. Unfortunately, this is not a new problem. We all remember the Leas Cross investigation 20 years ago and since then, numerous Governments have promised safeguarding legislation when it comes to this area. Safeguarding teams and social workers need a legal right of entry to residential facilities to ensure all appropriate measures are in place. It is an action I have long supported and one my party's spokesperson on health, Deputy Cullinane, has long advocated for.

We simply cannot rely on private companies to deliver services in this area. The unfortunate reality is that these companies are concerned with profits. That is why we saw the complete lack of medical and sanitary supplies during the documentary. We often hear of staff being urged to penny-pinch to protect the company's profits. That is not how an organisation tasked with caring for vulnerable people should operate.

In the longer term, we need to see investment in the creation of public nursing homes and community beds. We need the establishment of an independent safeguarding authority. I want the same outcome as the Minister of State, namely, the very best standard of care for our older citizens. If we all work together constructively, we can ensure the scenes we saw on our TVs will never be repeated.

Paul Gogarty (Dublin Mid West, Independent)
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As others have mentioned, the "RTÉ Investigates" programme highlighted the scandalous lack of proper care standards in two nursing homes. However, if people think such incidents in the modern age are confined to The Residence Portlaoise and Beneavin Manor in Glasnevin, they have another thing coming. We have all heard stories and, obviously, if they are not in the public domain, we cannot recount them. However, in this context I believe that HIQA, all related agencies and the system in general have failed families for too long.

To be constructive, I welcome the fact the Department of Health, in collaboration with the Department of Children, Disability and Equality, is finalising an adult safeguarding policy for the health and social care sector, hopefully before the summer recess. This will provide a framework for strengthening adult safeguarding structures, processes and supports.

The introduction of safeguarding legislation, if it is done properly, will set out some form of adequate safeguarding. Once the legislation is enacted, though, how will it be enforced? What additional actions will take place in terms of funding so that residents' needs are matched with profit maximisation in an increasingly corporate sector? We have heard references during this debate to the rise of investment funds. More than half of all nursing home needs in Ireland in 1990 were public but by 2023, only 16% of them were. The Geary Institute for Public Policy at UCD has highlighted that just ten investment funds now own one third of the nursing home beds in the State. This is a massive change, even from seven or eight years ago, when investment funds were essentially non-existent in the system. Ireland and the UK now have officially the most privatised sectors in Europe. Does this serve the residents, the families and, equally, the Irish taxpayer? With such private, profit-driven ownership now, the onus is on the State to provide a robust system of compliance. The ball is in the Government's court and it is not just about the legislation. It is about ensuring it can be adequately enforced.

Michael Collins (Cork South-West, Independent Ireland Party)
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The recent "RTÉ Investigates" documentary "Inside Ireland's Nursing Homes", which aired on 4 June, showed us all the terrible conditions in some nursing homes in the midlands and Dublin. We were all horrified and shocked by the programme and the way the most vulnerable in our society are being treated - by some. I do not want to tar everybody with the same brush. When we hear what is said in this House sometimes, and rightly so, in defence of innocent, elderly people being abused, it can seem as if staff in every nursing home are doing this, and they are not. I spoke to Mr. Tadhg Daly, CEO of Nursing Homes Ireland, at great length and he assured me there are great nursing homes out there. He does not need to tell me that because I have seen them. I have visited them. There is the Fairfield Nursing Home in Drimoleague, Bushmount Nursing Home and CareChoice in Clonakilty and the Skibbereen Residential Care Centre. All of these are providing a fantastic service to people and the families love the service they are providing. We need to get the point across that while there are bad apples out there and they need to be weeded out, not everybody is a bad apple.

I call into question HIQA and the way it carries out its checks, given that this was not spotted previously. It gets to the point where elderly people are being treated inhumanely and that is something I would not stand for, but it has not stopped.

We all know the crisis that it out there at the moment. I raised Perrott House in Skibbereen in the House with the Tánaiste last week. Families, who had people inside in Perrott House in Skibbereen, were told six or seven weeks ago that they are going to be moved. It is a mental health unit but it is for the elderly. They have had no communication since as to where they are going, whether they going long term, short term, being kept there or if they will they be able to return. The answers to simple questions are being refused to people. Basically, the families were rung and told not to be listening to Michael Collins in the Dáil at all. The families asked Perrott House what they were doing but were told "Sorry, we cannot tell you". That is another type of abuse.

I also mention the old Aperee Living Bantry nursing home. That is a crisis situation. It was closed down and now is almost across the line. The liquidator has it sold but there is a problem with HIQA and the liquidator, whatever it is. However, 17 beds are available there to be delivered for the people. It is very important that this would be looked into immediately and that HIQA would be asked to sit down with the liquidator, tell him the issues and get on with the sale of the nursing home. These 17 beds are closed and they had been brought up to full standard so we could allow people in. I have people all over west Cork pleading with me for a bed. Good God, they are pleading with me for a bed in a nursing home and to think there are 17 there. It is just a little bit of paperwork. It is no longer anything to do with the condition because the home has been brought up to standard. The sale has been almost approved but there is something holding up getting it across the line and people are suffering. HIQA has to stand up here and say, "Okay, let us get this right. This is the problem here." I have met HIQA officials but they are telling me due to GDPR that there are certain things they cannot tell me. The liquidator says he does not know what is going on so there is a problem. We need that resolved straight away in the old Aperee nursing home in Bantry so that we can have people guaranteed that they have safeguarded their homes going forward.

Richard O'Donoghue (Limerick County, Independent Ireland Party)
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The report by "RTÉ Investigates" makes me sick to my stomach that this could happen. I look at the nursing homes around Limerick and other nursing homes I have visited. Through social events that we do, such as vintage events, we recreate lives of people who are in the nursing homes. We bring in some of the older stuff in to them and see what the nursing homes do. I have been at a lot of nursing homes and we have done this. None of the bigger nursing homes, those with 100 beds or that, do this. The community nursing homes, the smaller ones with 25 beds all the way up to 50 beds, have done this. What is that telling us? Are we getting to a point now where companies buy out nursing homes and are just asking how many people they can get in and how many they can look after? It is a money trail rather than a care trail. I was in a nursing home that gives excellent care but it was an older nursing home. HIQA officials came in and said one of the bedrooms was four inches too small for its standards. The person who was in the nursing home said, "It is perfect, I love it and I am happy there." They had to remove the elderly person who was in that room, spend €20,000 to move a wall four inches because of HIQA standards, rather than going in and asking the person if it was acceptable to them, if they were happy there, if the nursing home was doing everything in its power to protect them and if they were looking after them and all their care. HIQA officials did not ask that; they looked at a book and decided the room did not meet standards. The standard is the care of the patient. The standard is the smile on their faces when they see you coming in and they say you are welcome. We have gone into nursing homes that are going industrial. They push them in, pack as many as they can in, have a limited number of staff and provide the minimum amount of community spirit in the place. If there are too many people in one nursing home in one setting, it becomes institutionalised. In smaller settings, which are smaller nursing homes, people seem to be happier. Why do we not put a cap on numbers so that nursing homes cannot have any more than 25 people? If they do, they need to have a separate setting, even a separate floor or whatever they have to do. That is the community. The community is built around the people in there and the care is built up. Instead of "RTÉ Investigates" going in, let us see whether it works and whether people are happy in the settings they are in and rate a lot of the nursing homes that are providing excellent care. We could rate them on that, promote the good ones and weed out the bad ones.

Paul Lawless (Mayo, Aontú)
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I could not watch the level of abuse in the "RTÉ Investigates" documentary. I could not stomach the way elderly people were treated and abused. What we saw was a complete disregard for human life and human rights and it was very focused on economic profits in this regard. Profit does seem to have been the motivating factor in some of the abuses. This is clearly concerning, particularly in light of the fact that Government has moved away from public nursing homes to a place where this care is primarily in the hands of the private sector. The Minister of State has a major job of work to ensure that HIQA has teeth, that there are very clear regulations and consequences when actions such as these take place. Over recent weeks, we in Aontú have opposed the Order of Business because we wanted to discuss this very important issue. We very much welcome the debate. I also welcome the Minister of State's contribution and his work in this regard. I want to see HIQA having teeth to address this. It is a fundamentally important way forward.

I also raise another issue. We saw during Covid, for example, the way nursing homes were abandoned. The entire sector was abandoned. We saw how elderly people were shipped out from hospitals by the National Treatment Purchase Fund into nursing homes. It caused a huge spread of Covid. We also saw how supplies, including PPE and oxygen that were meant to go to nursing homes, were actually intercepted by the HSE. These were meant to go to the people who were most vulnerable due to Covid and the HSE intercepted them and took those supplies to hospitals. That is a scandal that the Minister of State needs to investigate. We need that Covid inquiry. We need that Covid review to investigate this. By the way, "intercepted" is not my word; it is the word of the then Minister for Health, Deputy Stephen Donnelly, who stated that the HSE intercepted those supplies. One third of all Covid deaths happened in nursing homes. I commend the advocacy group Care Champions, which has emerged from these horrors to see justice and rights for those in the care system. It is a wonderful advocacy group and I hope the Minister of State will work with is representatives on this journey to ensure elderly people are treated with the dignity and respect they so desperately need.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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In recent weeks, distressing footage from "RTÉ Investigates" and "Prime Time" has brought into stark relief the vulnerability of many older people in residential care. What we saw was not just a breach of trust; it was a breach of decency. We must acknowledged that the vast majority of front-line staff in our nursing homes and community services do remarkable work. They care for our parents, grandparents and neighbours with compassion and dignity, often under huge pressure and without sufficient resources. However, the system around them and above them must do better. We need to be clear: mistreatment or neglect of any older person in care is unacceptable and must be met with accountability. HIQA plays a vital role here. I support its work but regulation alone is not enough. If we are serious about ageing with dignity, we need to invest in the whole spectrum of care from supports to live at home longer to high-quality residential options when needed. That includes delivering on the statutory home care scheme, properly staffing our community nursing units and ensuring that the fair deal scheme remains sustainable and fair. Crucially, we must also recognise the need for more geriatric social workers.

These professionals play a key and unique role in safeguarding older people, especially those living alone or in complex situations, yet their numbers are far too low. We need a national strategy to recruit, train and retain more of them.

Finally, while I echo the Government’s commitment to the forthcoming adult safeguarding legislation, we cannot delay. We need a full statutory framework that gives older persons explicit legal protections in the community, in hospitals and in nursing homes alike. Our population is an ageing one and the ageing population is also growing, which is a success story in itself. However, it also demands that we act not only to regulate but to care.

Micheál Carrigy (Longford-Westmeath, Fine Gael)
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We were all shocked by the recent “RTÉ Investigates” programme but it is important to put on record that this is not the case for the entire nursing home sector. Across the country, many nursing homes provide excellent service to our family members. We need to increase the support that we put into both public and private nursing homes.

I visit nursing homes on a regular basis in my county. A multi-million euro development is taking place on-campus at St. Joseph’s Care Centre and there is also Laurel Lodge in Longford town, Thomond Lodge in Ballymahon and The Manor in Edgeworthstown. I have been in all of these centres in recent years and in two of them with my late mother, who passed away during Covid in St. Joseph's Care Centre, where she got nothing but the best of care. That is something that we as a family will always be grateful for. She was also in The Manor. I visit my Uncle Bernie monthly in Thomond Lodge. Overall, I can say, hand on heart, that the care being provided in all the nursing homes in my county is excellent and nothing short of that.

Nonetheless, we need to strengthen the sector. We need to increase funding for the fair deal scheme and ensure the waiting list does not exceed four weeks. We need to build more public nursing home beds, as at St. Joseph’s in Longford. We need to provide a clear pathway for healthcare assistants, with better benefits. Ultimately, we need to invest in our older generation. We need to introduce the statutory homes scheme, which we have promised. We put it into the programme for Government and it is something we need to deliver on.

It is important to put on record the help and support of all those who work giving home help to elderly people throughout the country. The reality is that we do not have sufficient people to carry out that service and allow elderly people to stay in their own homes, where they are safer and more comfortable. That is why we need to address these issues. We need increased home help hours but also an increased number of staff to support those families who want to support their loved ones at home. As I said, the programme for government has been clear on the support we are going to give to persons in their elderly years and we need to deliver on that in the short term.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We have been here before. We have expressed the same degree of disgust and anger at what we saw on the “RTÉ Investigates” television programme recently but we have not done anything in between times to make sure it does not happen again. There is a lot that we could have done. For example, the community nursing homes are a great idea, as outlined by Deputy O'Donoghue earlier. We have them in Kilkenny at Thomastown, Castlecomer, Kilmoganny, Graiguenamanagh, Freshford and Callan. Why do we not fund them? Why do we not give them the money to have a proper community facility to look after the elderly in our communities? I have travelled to those different homes and I have to say I have always been impressed by the business model and by the level of care that those in the homes receive. Yet, we totally ignore that and we make them fight for every shilling or euro that they get.

Big business seems to be the favoured way of delivering nursing homes. It is not a good way because it is driven by profit where the profit is euro, whereas in the community setting, it is not euro but it is seeing the smile on the resident’s face. That is what it is. It is about choice. The Government can have its big business model and it can also have a well-funded option in terms of community care. I urge the Minister to tip the balance in favour of community care.

I urge the Minister to tell the discharge nurses not to give the commitment that certain plans will be followed when the patient is taken home because they do not have the staff. They release the bed, the patient goes home and then the family have to carry the can fully. At the end of that, the person goes to a nursing home.

It is shocking the way recent Governments have behaved in that they have not recognised the true value of community homes. I remember during Covid that the Taiwanese funded a lot of the equipment that went to care homes throughout the country. That needs to be put on record, as does the issue of care champions and what they have done. Where is the Covid inquiry? We want to know what happened. That Covid inquiry is probably on the long finger somewhere and it needs to be addressed. It is not right that we would announce it and talk about it, and then not get into the detail of what happened to families and elderly people in the course of the Covid times. I ask that this also be looked at.

I ask for the focus to be taken away from private homes, that we would not support them and that we would be very critical and emphatic in our actions against them when they breach the rules.

Séamus McGrath (Cork South-Central, Fianna Fail)
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I join with other Members in expressing my disgust and revulsion at what was exposed on “RTÉ Investigates”. When we see scenes like that on television, we think of our own relatives and friends who spend time in nursing homes. It makes every family wonder about the care they are receiving. Of course, it has to be said that what we saw results in a stain on all nursing homes across the country. However, as we know, the vast majority provide excellent care and the staff and management working in them do their level best to provide humane and compassionate care for their residents. Unfortunately, what we saw on our television screens did not live up to that in any shape or form. What we saw was very undignified and inhumane treatment of people in their most vulnerable state in their senior years, when they should have been receiving compassionate, caring and dignified care from those charged with the responsibility to provide care.

HIQA has a lot of questions to answer in this regard. HIQA is an organisation with good resources and powers but, unfortunately, what we saw on RTÉ shows that the regulatory system is not working, or not to the extent that it should. Given the tactics that RTÉ used in exposing this, HIQA needs to look at those tactics in order to get under the bonnet of what is happening in our nursing homes so it can expose the true result of what is happening. It took RTÉ to do this. What it did was outstanding work and it really exposed what we saw in regard to these nursing homes. I stress that, in my opinion, this is a minority across the country. At the same time, it should not be happening in any nursing home.

I have seen commentary regarding the need for the Government to step up resources in public and community nursing homes, and I fully support that. However, that is not the solution to this problem. There will always be private nursing homes. What we have to put in place is a good, robust regulatory system so all families across the country have confidence in the care that is provided for their senior family members. That is what is important. I hope that as a result of the good work that RTÉ did, this will be the ultimate outcome.

Rose Conway-Walsh (Mayo, Sinn Fein)
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The recent “RTÉ Investigates” exposé was shocking and shameful and the sheer lack of compassion and respect shown to the residents in that programme was appalling. We can only imagine the pain they and their families suffered, as well as the worry it has caused to others as a result. I commend RTÉ, although it should not be up to RTÉ to expose these atrocities that are going on.

My first question to the Minister is this. What protections are in place to prevent companies that have legal cases against them in other EU member states from operating in our care sector and, indeed, in other care sectors? Was due diligence or anything whatsoever carried out?

The failure in this regard is the first thing that is neglectful.

These shocking levels of neglect are the logical outworkings of commodification of care. What we have in this State is the profit model of care, which lends itself to large-scale operations driven by profit maximisation, as has been said. We must move away from the overdependence on this model. That is why, in Sinn Féin's alternative budget each year, we allocate investment to providing more public nursing home and community beds. Our provision last year was 1,200 beds. I commend the family-run nursing homes, community nursing homes and the many other facilities, including in my county, which provide excellent care for elderly people in a compassionate and appropriate way. It beggars belief that the Government changed policy in this regard. There is a responsibility on both Fianna Fáil and Fine Gael for the model we have. It did not just appear out of nowhere; it was Government policy.

It is no good Members opposite coming in here and commentating on the situation we are in when it was man-made by the Government. Community nursing homes and small, family-run nursing homes, and their staff, must be supported. Healthcare workers, nurses and other staff are too often faced with impossible situations that are not of their making. They do not make the decisions that lead to the lack of the most basic things required for human dignity, including pads, blankets and being taken to the bathroom, never mind provision of stimulation and joyful activities. Safe staffing levels should never be optional. Pay and conditions for many of these workers are abysmal for the level of responsibilities they have. Zero-hour contracts and the minimum wage are not conducive to the intensive care that needs to be provided for our most vulnerable. I support the calls for a Covid inquiry because it is the same healthcare workers who came face to face with the situation in nursing homes during the pandemic. We are still paying them the minimum wage or a little above. That is disgraceful.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The State has a long, sorrowful and shameful history of failing those within its care. Women, especially mothers, and children have endured the brunt of that long, sorry history. Whether we are talking about survivors of institutional abuse or the degradation of babies' organs; those responsible for delivering justice not only failed to deliver it but actively sought to deny justice. What invariably follows exercises in the pursuit of justice are attempts to delay and defer. Actions taken are rarely done in an accountable way and never in a timely manner.

This is not the first scandal involving nursing homes. Twenty years ago, the Leas Cross scandal led to the establishment of HIQA. At that time, a Fine Gael TD remarked:

There is a growing sense that "Michéalitis" is continuing in the Department of Health and Children. Deputy Martin was the epitome of this affliction. He always had to have another report from another commission. The current Minister is acting in the same way on this important matter.

Micheál Martin is back in office, this time joined by Fine Gael, and it seems the affliction described now equally affects Ministers of both hues.

My predecessor as Sinn Féin TD for Cavan-Monaghan, Caoimhghín Ó Caoláin, had the measure of the Government of the day when he remarked: "The Fianna Fáil-Progressive Democrats partnership has had nearly a decade to get health policy right and it has failed miserably. At the root of this is the Government's refusal to take a rights-based approached to healthcare." The crux of the matter is, indeed, the failure to take a rights-based approach to healthcare, namely, the right to dignified, adequate care for all people in their later years. HIQA will have to account for itself but Fine Gael and Fianna Fáil must account for their absolute failure in this area, which has ensured the shameful scandals of the past continue, shamefully, to thrive in Ireland today.

Michael Lowry (Tipperary North, Independent)
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For generations in Ireland, elderly people were mainly cared for in the family home. It was a given that younger family members committed themselves to caring for elderly parents and grandparents. Most homes throughout the country had three generations under the same roof. It was not always easy but it worked. It had to work because there were very few suitable alternatives available.

Ireland today bears little resemblance to the Ireland of those days. Life today is much more demanding. While home care for the elderly continues, financial pressures mean more couples need to have both partners working outside the home to meet their financial commitments. This makes providing full-time care for an elderly dependent family member in the home much more challenging. For many couples, giving up one job may mean losing the family home. As an elderly person's needs increase, the time and effort required to meet them also increase. Eventually, tough decisions must be made to ensure the well-being of everyone is protected.

For some, that involves an elderly person entering a nursing home. This can be a difficult decision, particularly when the older person is happy in the family environment. However, mobility issues and medical dependencies may leave little option. Many elderly people, after consideration, are happy to move into a nursing home and enjoy the daily routine that is geared towards their needs. There are excellent nursing homes across the country providing top-class care. The standard of all nursing homes cannot be judged on the basis of one television programme.

Many more families would choose to continue caring for older relatives at home if it were financially possible and viable to do so and if the necessary supports were in place. Increasingly, more people are opting to become a family carer for an elderly relative. These family carers provide 24-7 support. They put their lives on hold to ensure their elderly loved ones can remain in the comfort and familiar surroundings of their own homes and communities. They find themselves protecting the safety of the older person, learning to understand their individual needs, managing their medications, dealing with hygiene care and dietary needs, and arranging and accompanying the person to medical appointments. For the most part, they do this without organised suitable transport in place to assist them. Family carers are unsung heroes. They juggle an indeterminate number of tasks and are driven solely by care, love and the wish of their family member to remain living at home.

I strongly urge that the long-awaited adult safeguarding legislation due to be published by the Department be prioritised. The Bill will secure people's right to safety, dignity and respect. It must be subject to regular reviews and it must be widely publicised to make its objectives known and ensure its effectiveness.

Gillian Toole (Meath East, Independent)
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Everybody here is ageing. We are here to represent older people and it is incumbent on us to act with a focus on solutions and a sense of urgency. Most people will, hopefully, age well at home with the necessary community and healthcare supports initiated by older person's councils through the Age Friendly Ireland initiatives. I think of Ita Healy and Barbara McCool in Meath, who are tireless champions for older people.

Some people, for a multitude of reasons, will require nursing home support. There are many excellent places in Meath East where caring, competent and empathetic teams look after residents. However, so much is based on trust. The questions that must be asked are whether residents are safe, if the care is excellent and how care can be improved and provided as close to home as possible.

Twenty years ago, the Leas Cross scandal had a significant impact, leading to the setting up of HIQA. Standards of care improved and robust inspection systems were established for a time. In August 2020, the report of the Covid-19 nursing homes expert panel made 86 recommendations, including a framework for safe staffing and skills mix. Whistleblowing GPs voiced their concerns. Marcus de Brún and others, now awaiting fitness to practise hearings at a time when we need GPs in communities, had their concerns ignored and were vilified. As of now, the framework is still in development and remains to be implemented.

Interdepartmental collaboration on this issue is most welcome. The forthcoming safeguarding legislation is to be commended. Private operators must uphold the highest standards of care. They can afford to invest in their people and facilities. HIQA must be adequately resourced and whistleblowers must be listened to. Forward planning for ageing well is critical. Life is precious and the later lives of those who built this country must be planned for, safeguarded and valued.

Mattie McGrath (Tipperary South, Independent)
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Everybody was shocked and disgusted at what we saw in the recent television programme but it is the tip of the iceberg as regards big business and what is going on with big conglomerates. I salute all the care workers and nurses in the small nursing homes in Carrick-on-Suir, Clonmel, Cahir, Cashel and Tipperary town.

I salute them and the work they do. I challenge HIQA. It is not fit for purpose and has not been for a long time. It is the same with Tusla, which cannot even count the children in its care who have gone missing. HIQA is totally unfit for purpose. I saw how it bullied a nursing home in Carrick-on-Suir out of business some years ago by restricting the number of beds it could have open until it would do what HIQA wanted. Why can we not tackle this with the big conglomerates? There is fun and games going on here. I would say money or something else is changing hands. It is not acceptable. We have made a commodity out of healthcare and that is totally unacceptable. We must dismantle HIQA and Tusla and set up some reasonable organisation that will look after people.

Carol Nolan (Offaly, Independent)
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To call what we have seen revealed in some of our nursing homes a betrayal would be an understatement. It is brutality and the vicious erosion of trust. It is sickening to the core. I hope that each and every person who was seen abusing our elderly people will be arrested. I want to see their ability to ever work in such settings removed for life. These people who abuse our elderly are nothing short of animals engaged in the brutalisation of our loved ones. There must be no mercy shown to them and no excuses about regulatory failure must be offered. They are a stain on the good name of genuine nursing staff and all those nursing homes that cherish their residents. The signal must go out that, if you mistreat our elderly, you will be jailed and that, if you violate their dignity, you will answer for it before the courts and not just before some professional standards tribunal. People are fed up. We want accountability.

Danny Healy-Rae (Kerry, Independent)
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Like everyone else, I was horrified by the "Prime Time" exposé. We have great nursing homes both public and private in County Kerry. We have great staff. They are second to none and do their very best. I cannot understand why different rates are paid to public and private nursing homes. I cannot understand that. There is no better place for elderly people to age than at home. We should strive to bring more of that model in here. That is the model in places like Denmark. They are better off staying in their own homes for as long as possible. When that fails, they have to go to a nursing home because they need special care. There needs to be accountability but HIQA is apparently only looking at buildings, doors and windows and not at the people themselves. That is very important. Old people brought us to where we are today.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank all the Members. Some 40 Members spoke in this debate. People were very constructive. Like everyone else, I was shocked by the programme. It was wanton neglect and abuse. I thank the Members for their very constructive engagement.

I will attempt to cover the areas that people brought up. What we saw happening on the programme was pure wanton neglect and abuse of older people. It is as simple as that. We have to make the system better and more robust. How do we go about doing that? As HIQA itself has acknowledged, we have to look at whether the processes can be improved. Every system can be improved. That will involve looking at processes. There are things we can do like making reports in real time. At the moment, the reports that are published are historical. To make them up to date would be a very straightforward thing.

I also want to see the safeguarding legislation. The programme for Government commits to bringing a policy on safeguarding to Cabinet. That will include bringing forward safeguarding legislation. I am utterly committed to that. We are actively working on it. It is a priority for Government for the Minister, Deputy Carroll MacNeill, and I to bring it to Cabinet and to put it in place. We also have to look at how we regulate the groups. The parent companies are not regulated by HIQA. We need to change that. That is a procedural thing.

I will refer to something that came up in many of the contributions. What we saw in the two nursing homes on the "RTÉ Investigates" programme was horrific but, while I commend RTÉ on the programme, there are an awful lot of very good nursing homes out there. People are delivering a great service in their communities.

Sláintecare came out of the health committee. It was a cross-party document adopted by Government. It was about bringing care back to the home. The programme for Government commits to bringing forward statutory home care. It is a priority for me as Minister of State. The first step is bringing forward legislation on home care providers. Such providers are not currently regulated. Thereafter, we must look at how we define statutory home care and then put a statutory home care scheme in place. This is something I am passionate about and that we are very much committed to. It has come up repeatedly. People prefer to live in their homes if at all possible. Nevertheless, there will always be a requirement for long-term residential care. We have to ensure we have a system in place that is properly regulated and that ultimately provides good safe care to older people.

A couple of other points came across as well. At the moment, HIQA goes to the District Court to impose fines on providers. We are very open to giving HIQA the power to impose fines directly. These are matters we will look at. We are considering all aspects. HIQA is also doing a review itself.

Deputies Barry Ward and Máire Devine brought up two cases. I ask them to report those cases. If people are being abused, they should report those cases to HIQA and the relevant authorities and nothing less. I welcome that the subjects of the RTÉ investigations have been referred to An Garda Síochána. I expect that the chief inspector in HIQA will use the full powers available to him. We have to ensure that what happened to older people here can never happen again.

One of the key elements of statutory home care is home care hours. We have significantly increased the funding in recent years. We have virtually doubled it. However, I take the point with regard to delivering an enhanced service. I have met with the HSE directly to see how we can speed up the provision of service to people who are on waiting lists. That is very important.

One of the other features that came across was the design of nursing home settings. The Department of Health has a body of work under way on the design of nursing home settings. I very much wish to progress that.

Deputy Toole brought up the issue of safe staffing. Apart from the safeguarding, there is work ongoing in the Department with regard to a safe staffing framework. We are due a final report very shortly. I very much want to work on and expedite that because it is very important. With regard to safeguarding, the health (adult safeguarding) Bill is on the legislative programme. We want to progress that.

One of the other items that many speakers brought up was the provision of community nursing home beds. We are undertaking a capacity review in respect of public nursing home beds. The programme for Government commits to increasing the number of public nursing home beds. We are working through and finalising a capacity review. I want to enhance the provision of community nursing home beds the length and breadth of Ireland.

We will always have a mixture of community, voluntary and private homes. That is why regulation is so important. It is also highly important to note that there is a very good standard of nursing home care across all sectors. What we saw in the programme was the complete opposite.

It was pure neglect and abuse of older people. It is something that I feel very strongly about and that we cannot tolerate in any circumstance.

This has been very traumatic for the people in the two nursing homes and the wider nursing home body and the very good and dedicated staff and providers elsewhere. What has to come out of this is a stronger, more robust system. We have to look at HIQA's current powers in respect of the day-to-day operation of nursing homes. It has publicly acknowledged that we need to review the process. How can we improve the system such that what happened, and what we saw on the "RTÉ Investigates" programme, never ever happens again? That is something we are committed to as a Government.

Furthermore, we have an ageing population, as people have said. That is something we should celebrate. People are living longer, but with that comes challenges. The Government in the past year set up the commission on care for older people. That is chaired by Alan Barrett and is due to report. The first element of its report will be about the existing services and whether they can be improved. That will include the provision of nursing home care. I met with the commission some time ago. I very much want to see the report and the commission's recommendations. Once the commission on care reports, a cross-departmental group will be established under the auspices of the commission to consider whether supports for positive ageing across the life course are fit for purpose and to develop a cost implementation for options to optimise these supports. The commission on care has a key role to play.

Following the programme, I had engagement with HIQA and the HSE in terms of their safeguarding teams. They have been into both nursing homes and they will engage with all nursing homes throughout the group. They have put directors of nursing into both nursing homes. Ultimately, out of this absolutely terrible situation for people in both these nursing homes, the Residence in Port Laoise and Beneavin Manor, we want to get a better system in terms of the regulation of nursing homes to ensure that all older people, wherever they are in a nursing home, get a standard of care they deserve. It is something that in my role as Minister of State with responsibility for older people, along with the Minister, Jennifer Carroll MacNeill, we are determined to achieve, with Members' help.