Nicole Ryan (Sinn Fein)

In his opening statement, the Minister of State said there were a lot of nursing homes and care homes that did great work, and I agree with him. We cannot tar every single nursing home with the same brush because there are really hardworking people out there doing good work. However, last week, the Oireachtas health committee was presented with a deeply unsettling picture of how the State treated its older people and how little we had learned from the shame of the Leas Cross scandal 20 years ago. We were told that 95 nursing homes were under review by HIQA after serious concerns were raised. Of these, 52 were HSE-run centres, one was a stand-alone home funded by the HSE and 42 were private facilities, 23 of which were stand-alone homes. These numbers are not just statistics. They represent residents at risk, families living in fear and staff under pressure in a system that is failing from the top down. Despite this, we continue down the path of privatising care, handing over the welfare of our most vulnerable citizens to private operators, many of which are driven by profit and not by care. How can the State genuinely claim to exercise meaningful oversight when it has outsourced the majority of this responsibility to the private sector?

How can HIQA hold providers accountable when it is constrained by limited powers and its inspections are often focused more on compliance checklists than on the residents and their lived experience? Last week, the Minister of State appeared before the health committee and stated that HIQA had powers through the courts system. However, HIQA is advocating for more powers to enforce rules. Which is it? Is the Minister of State seriously saying that the only way families can get justice or for care homes to be closed is to drag people through the courts? We heard about homes where staffing shortages were so severe that residents were left without timely care and basic hygiene was not maintained. I reiterate that provision was not made for the basic hygiene of these residents. Safeguarding concerns were raised but they were not acted upon swiftly and families were stonewalled when they tried to raise the alarm. What does the State think of the older generation if they cannot even have their basic needs met or a dignified way to live in their remaining years?

The privatisation of nursing home care has led to a patchwork system in which the standard of care is often determined by your postcode, your provider or your ability to pay. This is not a care system but a market, and markets do not protect people. Regulation does protect people but only if it is robust, independent and backed by political will. The State is funding private care but failing to hold it properly accountable. In HIQA, we have a regulator that is supposed to be a safety net but last week we saw that there clearly were many holes in that net. After Leas Cross, we were told "Never again". That was 20 years ago but here we are again.

This about more than just governance; it is about values. Do we value our older people enough to protect them with strong public services, proper staffing ratios and real accountability? Do we believe that the private market should be the default for elder care or that dignity in later life should be guaranteed publicly? As a State, we have a moral and legal obligation to those in care. At present, we are failing on both. We cannot continue to speak about dignity and compassion while outsourcing care to underregulated, profit-driven providers. The time for reviews and reports is over. Action is long overdue.