Patricia Stephenson (Social Democrats)

I thank the Minister of State and the other contributors. We were all appalled and disgusted by the "RTÉ Investigates" programme, which made for really disturbing viewing. It showed how older people in our communities are being neglected and failed by those responsible for their care. I worry about the reactionary response we take when we see a documentary or TV show that precipitates discussion. It makes us take action and have statements. While I understand the drive for that, my concern is that it means we are reacting and not being proactive. It comes from all the things we have heard from Senators Costello and Nicole Ryan about the challenges with HIQA, in that we are reacting to a documentary instead of having a system in place to catch these things in the first place. It has already been referenced that we have had scandal after scandal in Ireland involving the care of a lot of vulnerable people. We spoke earlier this week about the Farrelly commission. There does seem to be a pattern involving vulnerable people and older people in communities.

HIQA was set up in response to previous scandals. It is ostensibly responsible for inspection and monitoring of conditions in these homes, yet the operating model of HIQA's inspections are not meaningful and do not have credibility. The inspections must be reviewed as they are not effective or meaningful in their current form. We heard that not all homes even come under its remit. HIQA is also incredibly understaffed and under-resourced. Senator Costello spoke powerfully about those matters in her intervention.

We have a reliance in Ireland on the private sector for the delivery of many different services, but especially for the care of older persons. That is a big issue here. Outsourcing the care of our loved ones to for-profit companies is a deeply problematic model. As soon as we outsource the care of any vulnerable person, be it an older person or a vulnerable younger person or adult, to the private sector, which involves the concept of profit, we then look at margins and how we can make the most money. That is often how we see the private sector working. I accept that is not the case with all homes. Senator Ryan made that point as well. However, when we have a model based on private care, this is an inevitability. For that reason I would like to see an expansion of the public model to all nursing homes. Research has shown that the quality of care delivered by private systems compared with public ones is systemically worse. The majority of nursing homes are run for profit – 81% in 2023, which indicates the vast majority of them. The reality is that private models lead to worse outcomes for people. We in Ireland have the most privatised care of older people in communities of anywhere in Europe.

Senator Costello referred also to another key issue, which is the lack of adult safeguarding legislation. We spoke about this at length since I became a Senator. I know there are plans to introduce legislation. Senator Clonan, for example, has plans to do so. It is also a commitment in the programme for Government. This is urgent. It is something that needs to be fast-tracked. It is not something on which we can sit on our laurels any more. It has come up again and again in this Chamber, as it relates to various scandals, which reinforces the need for adult safeguarding legislation. The gap in that regard is leading to systemic failures for the most vulnerable in society. We are in contravention of the UN Convention on the Rights of Persons with Disabilities. Linked to that is the idea of mandatory reporting when abuses of vulnerable adults are encountered, much like the system we have for mandatory reporting of abuse against children. I question why it has taken this long for the Government to take action because we have had scandal after scandal. I hope we are not sitting here in six months still calling for adult safeguarding legislation when some other horrific case arises. We must see this as a precipice and that we choose to take this action and put the systems in place.

I accept the HSE has a safeguarding policy, but it does not necessarily have a remit over the private sector. We have a public sector model with a safeguarding policy. I hope all of the private sector organisations are obligated to have their own safeguarding policy. Perhaps the Minister of State could respond to me on that in regard to how it links in in terms of compliance with the HSE policy. While we might expect HSE nursing homes to have a safeguarding policy, it would be interesting to know if the same level of compliance is expected of the private sector nursing homes. Does it really matter if inspections are not taking place?

The Minister of State could correct me if I am wrong, but it is a glaring gap if HSE social workers cannot meet residents in private nursing homes in that they do not have the right to enter them. The whole point of a social worker is to examine the conditions in a nursing home, and if they cannot do that, it is incredibly problematic if it takes a documentary film maker to go in and investigate the situation.

We should take a rights-based approach to these conversations. We should take a rights-based approach to all of these various issues. That should be at the core of our legislation. Given that 81% of nursing homes are in the private sector and are being run for profit, we are not focusing on a rights-based approach. If we take a rights-based approach to the care of older people in society, we will have better outcomes for them. That is my request. I urge the Minister of State and the Department to make progress in that regard so that we are not sitting here in six months' time or in a year's time having the same conversations about adult safeguarding. We can look back at debates from previous Dáileanna and Seanaid where this has been discussed. On that basis, I question the urgency of the Government's commitment to doing that.