Marie Sherlock (Dublin Central, Labour)
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6. To ask the Minister for Health her plans to strengthen the inspection and regulatory regime in HIQA; and if she will make a statement on the matter. [34932/25]

Marie Sherlock (Dublin Central, Labour)
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We are all reeling from the revelations about Beneavin nursing home and the nursing home in Portlaoise in recent weeks. It is clear that HIQA has given a wide berth to nursing homes when it comes to its inspection regime, which is in sharp contrast, I might argue, to how other authorities regulate, such as the Food Safety Authority and the Health and Safety Authority. I wish to hear from the Minister and Ministers of State as to how the inspection and regulatory regime will be strengthened within HIQA.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will answer on HIQA specifically and ask the Minister of State, Deputy O'Donnell, for his perspective as well. HIQA plays a crucial role in ensuring high-quality and safe care for patients using our health and social care services. The Government strongly supports HIQA in maintaining and strengthening its critical regulatory role. While it provides an important role, it also needs improvement. A number of changes to both primary and secondary legislation have been made in recent years to expand and reinforce HIQA’s functions. Under the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, HIQA’s remit has been expanded into private health services and hospitals. Other legislative amendments have strengthened the regulatory framework in nursing homes, giving HIQA additional new powers in the areas of enforcement, data collection and compliance notices.

My Department has committed significant financial support to HIQA, reflecting its expanded regulatory role. The budget allocation of non-capital expenditure from my Department to HIQA in 2025 is €35 million, which is a considerable increase of more than 60% compared with the €21.4 million allocation in 2022. It is likely HIQA’s regulatory responsibilities will expand further under future developments, such as the patient safety (licensing) Bill, the provisions of which I took to Cabinet this week.

I met with HIQA last week. Along with the Minister of State and I, it is considering what is needed to further strengthen its regulatory role and processes, in particular to reflect the changing dynamic of the nursing home market and sector and the ownership structures within those. That is important. I will continue to work closely with HIQA in reviewing its powers and exploring ways to improve and strengthen its inspection and regulatory regime. As I said, that includes exploring how HIQA can best deal with regulating larger corporate entities that operate in the nursing home space.

It is important to say - and I know the Minister of State, Deputy O’Donnell, has been strong on this - that there is a need to report in real time, rather than some months later. We must have better visibility over this at an earlier stage. HIQA is an important institution in this State which has done exceptionally good work. I have good confidence in it. Everything, be it this House, HIQA and everything else, needs process and institutional development improvement in response to these events.

Marie Sherlock (Dublin Central, Labour)
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I thank the Minister. There are four clear systemic issues within HIQA at the moment, notwithstanding that it is a much-trusted institution in the public's mind. That confidence has been dented, however. Clear legislative change and clarity are needed in four areas. The first issue is in regard to the licensing. I welcome what the Minister is saying about the licensing of corporate institutions and their intervention into the market. The second issue is the inspection regime. There is a large degree of ambiguity as to the point in which HIQA can intervene on the basis of an individual complaint or its own inspections. The third issue is enforcement. It is crazy we are having this debate about whether it can fine. While HIQA has powers to go to the District Court, it has never used them. The final issue concerns liability. There is a glaring gap in that regard. Liability on the part of directors does not appear to be pursuable. While staff are going to be pursued for wrongdoing, and rightly so, there must also be liability on the part of the directors.

Kieran O'Donnell (Limerick City, Fine Gael)
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The Deputy and I have engaged intensively at the health committee. I will go through the points she raised. With regard to the licensing, there is absolutely a lacuna there at the moment. Within a group of companies, the licensing inspection is on individual nursing homes and who they are run by, but the parent company is not under HIQA's remit. I want that to be changed. There is an acceptance in that regard.

In respect of the inspection regime, HIQA does an inspection on the day. When it publishes its report, which might be a number of months later, it is based on that inspection. I want to see that report updated with the current position of the nursing homes and whether they have complied with any conditions required of them under the inspections. That makes common sense.

In the context of HIQA’s enforcement powers, it is correct to say that HIQA cannot issue fines directly. We have no issue in this regard. It is something HIQA recommends and we very much support.

When it comes to liability, these are all areas we are looking at. The key thing is that HIQA has acknowledged the need for change in terms of updating schedules. We will work with it on that.

Marie Sherlock (Dublin Central, Labour)
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There is an added piece with regard to leadership. In the responses at the health committee last week, in the instance of Beneavin nursing home, there is 100% non-compliance with fire safety systems in that building. We were told that it does not relate to the structure, but rather only to the fire systems.

If the fires systems are not fully operational, there is an immediate fire risk. It may not happen today or tomorrow, but it could happen at some stage and there is a very real patient safety risk. To hear that sort of response and lack of urgency on the part of the leadership of HIQA is deeply troubling. There needs to be very clear action taken to ensure that the leadership team of HIQA is fit for purpose.

Kieran O'Donnell (Limerick City, Fine Gael)
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The context here is quite simple. I always go back to the needs of older persons in nursing homes. What we saw in that programme with the residents in the nursing homes in Portlaoise and Beneavin was wanton neglect and abuse of older people. We want to look at the regulatory system and how we can improve it. All aspects will be considered. This is ultimately about improvements and ensuring that older persons have the right and entitlement to be in nursing homes that are safe. We are working with HIQA to ensure that we enhance the regulatory system.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is exceptionally important to acknowledge that our focus here is on HIQA, but HIQA did not do and did not enable what happened in the nursing homes. I want to take a moment to reflect on the fact that the provider and the individuals involved are ultimately responsible. We will also work with HIQA but let us first and foremost direct our ire at the providers of the nursing homes.