Long-Term Residential Care: Motion [Private Members]

I move:

"That Dáil Éireann:

notes that:

- due to the Covid-19 pandemic, guidance on visitation to long-term residential care facilities was issued by the Health Protection Surveillance Centre, which included requirements to facilitate window visits during all levels of pandemic restrictions;

- this guidance was not placed on a statutory basis and there was no authority which could compel its implementation, monitor compliance, or sanction a non-compliant

facility;

- nursing home residents, their families, advocates, and social workers have been raising concerns since the beginning of the pandemic that this created an unsafe environment, and warned of high risks of neglect and abuse, and that residents would suffer heavy consequences from isolation;

- concerns were raised by nursing home representatives regarding the testing protocols and procedures around discharging hospital patients to care facilities, staffing levels, and ability to comply with regulations;

- nursing homes received financial assistance from the State to aid with pandemic protection measures;

- more than 2,000 nursing home residents have died due to Covid-19, equating to more than 40 per cent of Covid-19 related deaths in the State; and

further notes that:

the Health Information and Quality Authority (HIQA) has warned successive Ministers for years that the regulatory, governance, and safeguarding framework for the older persons residential care sector was insufficient;

the Department of Health has yet to advance safeguarding legislation despite years of mounting evidence for its need;

there is no designated independent authority with powers to investigate individual complaints of neglect or abuse in the social care sector, and that Health Service Executive Safeguarding and Protection Teams are not empowered or resourced to investigate; and

social workers are the regulated professionals who are trained for safeguarding and the protection of vulnerable people; and

calls on the Government to:

- commence a full public inquiry into the deaths of residents and quality of care in nursing homes during the Covid-19 pandemic, and systemic failures in the sector;

- place Long-Term Residential Care Facility (LTRCF) visitation guidance on a statutory footing and give interim authority to HIQA to enforce it;

- expedite adult safeguarding legislation, including legal right of entry and powers of investigation for appropriate authorities;

- ensure all residents are treated as community clients with direct access to safeguarding social work services and all primary care services, including an independent social worker liaison attached to each Covid-19 cluster in LTRCFs;

- empower a State agency to independently implement, monitor, oversee and enforce safeguarding legislation and investigate individual complaints in the social care sector;

- fast track reforms to empower HIQA with improvement and compliance notices and improve social care sector regulations in line with HIQA advice;

- mandate reporting of neglect and abuse of residents by all staff in nursing homes to both An Garda Síochána and social worker Safeguarding and Protection Teams; and

- introduce accountability at an organisational level, in terms of penalties and criminal offences, where failures to govern safely in accordance with HIQA regulations result in loss of health or life for residents in care of the service."

I am sharing time with a number of colleagues.

The pandemic restrictions, combined with poor oversight of the nursing home sector, gave rise to a perfect storm that led to neglect and abuse. Our starting point has to be to acknowledge what happened. There is a responsibility on the State and the sector to acknowledge and deal with their failings before and throughout the pandemic. To protect the vulnerable, severe restrictions on access to nursing homes and long-term residential care facilities were put in place. In truth, this was an afterthought and there is more than enough evidence to suggest the State did not have sufficient knowledge of the sector it was dealing with. The pandemic exposed major and fatal flaws in our health and social care system that should have been known. Even by the third wave, many nursing homes were overwhelmed when outbreaks caused major staff shortages, as homes competed with each other and the HSE for staff.

The crisis exposed a sector that was fragmented, neglected and poorly governed, without adequate clinical governance and based on a weak regulatory framework. For years, HIQA, the regulator responsible for the sector, made recommendations to address these deficits and strengthen sectoral governance and regulation.

The Irish Association of Social Workers, IASW, and family advocates, such as Care Champions, have for years been pointing to flaws in the State’s governance of nursing homes and the lack of safeguarding legislation to prevent abuse and neglect. Indeed, safeguarding legislation was introduced in the last Seanad by Senator Colette Kelleher. However, the previous Minister for Health, Deputy Simon Harris, did not accept or advance it. The advice fell on deaf ears and avoidable deaths, abuse and neglect were the consequences. In the last 18 months, more than 2,000 nursing home residents and staff sadly passed away from Covid-19, in instances related to outbreaks in their care homes. That was more than two-thirds of the deaths linked to outbreaks, and it does not factor in the quality years lost due to isolation and neglect. While the restrictions were necessary to reduce mortality, the prolonged isolation they caused for many was not. When visitation guidance for nursing homes was introduced, it allowed window visits at all levels of the plan. However, families and social care workers raised the alarm in this regard. It was not enforceable and this plan would lead to isolation and harm. The guidance was not the law. Nobody was given the authority to implement it, monitor compliance or sanction non-compliant nursing homes.

I have engaged in recent weeks with many families who lost members in nursing homes. They are not seeking to apportion blame, but they are seeking justice and the truth. Many of us will have seen the "Prime Time Investigates" programme several weeks ago which again set out harrowing accounts of people who could not see their loved ones before they died in nursing homes. Included were the stories of people who could not even watch their loved ones from a window of the nursing or care home. There were difficult and harrowing accounts, in some cases, of neglect or what could be described as abuse. This was all because of systemic failures in the sector. Many people working in the public and private nursing home sector did their absolute best, but we must also acknowledge that many of them were let down, as were the families and residents.

The starting point here must begin with establishing the truth and the facts of the situation. That is why this motion calls for a public inquiry, and it is necessary. We also want to see the visitation guidance for nursing homes immediately put on a statutory footing and the Health Information and Quality Authority, HIQA, should be given the interim authority to enforce it. Adult safeguarding has been promised time and again. It is a commitment in the programme for Government. It must be delivered and it must include the expediting of the legal rights of entry and power of investigation. No statutory authority or State agency has a right of entry into private nursing homes to investigate individual cases of neglect. That is wrong and it is a wrong that must be put right. We must fast-track reforms to empower HIQA, which has been stating for some time that its powers are blunt instruments. The organisation needs the ability to issue compliance notices and to improve social care sector guidelines in line with its recommendations. We also need accountability at an organisational level in situations where the failure of a nursing home to govern safely results in a loss of health or in death for residents in their care.

Therefore, serious issues must be dealt with concerning nursing home care and care of the elderly. We all know we need a new strategy and plan in this regard. It will only happen, however, if the political will is there to make it happen. The starting point for that must be a public inquiry to establish what happened in those nursing homes at that time. We must also put in place adult safeguarding measures, empower HIQA to be able to do its job and make more prominent the role of social workers and social care teams and the work they need to do to keep people safe in care homes.

Nelson Mandela once said that "A society that does not value its older people denies its roots and endangers its future". This Government has well and truly endangered our society’s future by its failure to implement proper safeguards. Our older people have suffered disproportionately during this pandemic. More than 2,000 residents of nursing homes have died due to Covid-19, accounting for more than 40% of Covid-19-related deaths in this State. We need a full public inquiry into the deaths of residents and the quality of care provided in nursing homes during the Covid-19 pandemic. The systemic failures in the sector must be addressed immediately.

Many concerns were raised by nursing home representatives concerning the testing protocols and procedures in respect of discharging hospital patients to care facilities. Those concerns fell on deaf ears. Concerns were also expressed about staffing levels and the ability to comply with regulations. Reaction to these concerns was slow. This is not good enough. If Sinn Féin was in government, we would have extended the temporary assistance scheme which provided supports for nursing homes to enable them to ensure that the right precautions were in place. This Government has ignored our calls to extend this scheme. It is wrong for the Government to put nursing homes again in a disadvantaged position. This is a vital support scheme to deliver public health recommended measures and its removal is a kick in the teeth for the sector.

It is high time that the Government got serious about the response to Covid-19. We must see a less reactive and much more proactive approach to this response. The approach taken by the Government concerning visits to nursing homes must recognise that we are dealing with real people. As I have said here before, loneliness is a killer. It is associated with higher rates of depression, anxiety and suicide. Loneliness among heart failure patients was associated with a risk of death that was four times higher, a risk of hospitalisation that was 68% higher and a risk of visits to accident and emergency departments that rose by 58%. Our older people have given the State much service and we must do better in repaying them.

As early as last summer, it was revealed that there were 43 deaths at six different nursing homes across County Wicklow due to Covid-19. Those included the deaths of 24 people in Bray, with ten people passing away in just one nursing home in the town. Twelve people lost their lives in St. Brigid's nursing home in Crooksling, on the border between Dublin and west Wicklow. Another seven people died in nursing homes in the rest of the county. That is a total of 43 deaths in nursing homes in Wicklow in the first few months of the pandemic.

The first confirmed case of Covid-19 in a nursing home in Ireland was on 13 March 2020. On 23 March, the first resident at Crooksling tested positive for Covid-19. Despite this, the HSE seemed to fast-track pre-existing plans to close the public nursing home. Forty-six of the residents were transferred to Tymon North nursing home in Tallaght, two residents were moved to Baltinglass hospital and one resident was moved to the Maynooth community care centre. The transfer of those residents happened while eight of them were awaiting test results for the virus. Twelve of those residents died and 34 members of staff tested positive for Covid-19.

Many questions remain unanswered as to why these residents were moved in the midst of a serious outbreak in the facility and what impact the move had on the spread of the virus. The now Minister for Health, Deputy Stephen Donnelly, stated last year that nursing homes in Wicklow and elsewhere were left "screaming [out] for help" and they did not get it. He also stated that his work on the Covid-19 committee had painted "a dark picture" of how Wicklow's nursing homes were dealt with by the State. I agree with him. The reality is that the former Minister for Health, Deputy Simon Harris, has serious questions to answer regarding how he managed and handled this situation. The Minister for Health and the Minister of State can now ensure that the calls for truth coming from families who lost loved ones are listened to and acted upon. Will the Minister of State ensure that the families get the answers and the truth they require or will she engage in the policy of the suppression of information, something which has plagued this State for far too long? We need clarity and information. The families need that and we need a public inquiry now.

I call on all parties and none to take this motion seriously, as it deals with a subject of concern for many families across the country. I pay tribute to the staff of the nursing homes who worked so hard under extreme pressure and in extremely difficult circumstances to look after our loved ones.

Their work is hugely appreciated. The nursing home managers who went to great lengths to ensure their facilities were full of kindness, support and security must be thanked on behalf of the many families who missed their loved ones for so long.

Unfortunately, the sector as a whole found itself in an unprecedented situation, which made it difficult to cope effectively. When Covid first struck, our nursing homes came under particular pressure. Figures reveal that up until the end of May, 2,051 deaths had been linked to clusters and outbreaks in nursing homes. Many nursing homes were unprepared for any infectious disease outbreaks. The consequences for many families were devastating. Each of these tragic deaths represents an individual and behind each individual is a family that has had to grieve the loss of a loved one through circumstances that were unexpected and for reasons that, in many cases, remain unknown.

There have been instances of poor governance and understaffing, and the poor provision of safeguarding measures was evident in particular nursing homes. Sadly, we have also seen instances of neglect. Many homes in the sector were unable to cope effectively due to chronic understaffing, weak governance arrangements, poor safeguarding provisions and a lack of investment. The recent "Prime Time" programme gave us some examples of these issues but unfortunately it was not an exhaustive account. It is for these reasons that Sinn Féin is backing families' calls for an inquiry to establish what went wrong and ensure that changes are made in order that such a devastating situation does not happen again. These calls have been echoed by Care Champions, an organisation that represents residents and their families and is supported by the Irish Association of Social Workers.

An independent safeguarding authority must be established within an appropriate State agency and adult safeguarding legislation must be expedited. Mandatory reporting of suspected neglect or abuse must be the norm across the sector and workers who come forward with concerns should be supported and protected. These reforms must also clarify legal rights and give social workers the right of entry and powers of investigation in suspected cases of neglect or abuse. Sectoral regulatory and governance reform must be fast-tracked in line with HIQA's proposals. Accountability at an organisational level, with appropriate penalties including criminal offences, must be put in place where a failure to govern safely results in harm or the death of residents. Residents in nursing homes deserve to get the best possible care and to know that they are safe. The mistakes of this pandemic must be learned from to ensure they are not repeated. I call on all Deputies to back Sinn Féin's motion and ensure these changes are delivered.

This motion would ensure that the safety, protection and rights of residents in nursing homes are safeguarded and that a public inquiry is established. Care Champions and the Irish Association of Social Workers have led the calls for a public inquiry and we support those calls. Covid had a significant and fatal impact in many nursing homes and the hurt and pain experienced by many will linger for a long time to come. Only a public inquiry will bring comfort for those residents who are still with us and for those families who have lost loved ones.

We need stronger regulation of the nursing home sector and we need a much closer relationship between care for older people and the State. The Covid crisis in nursing homes was made all the worse because the private system that operates the majority of nursing home provision in Ireland is too removed from the public system and the HSE, so it took too long to agree and implement a strategy. In many cases, older people died needlessly and the health of those who survived has deteriorated greatly. This is unforgivable.

The experience of isolation from loved ones has caused so much hurt and harm and we will never know whether this harm can be repaired. Lessons must be learned from this. The legacy of the Covid nightmare in nursing homes must be one of improvement and the protection of rights. Safeguarding legislation and a new model of providing eldercare based on home care and independent living outside of congregated settings must be the future. The only way we can understand what happened and why so many people died and prevent something similar ever happening again in the future is through a public inquiry. It is the only way we can establish the facts and ensure we can change the future positively.

I commend this motion and welcome the opportunity to support families' calls for a full public inquiry into nursing home deaths during this awful pandemic. From the outset, I have been anxious and worried about how the Covid pandemic was handled in our nursing homes. That is why almost a year ago, during one of my first speeches, I called on the then Minister for Health, Deputy Simon Harris, to establish a quick, Scally-type inquiry into what happened. My constituency of Kildare North took a disproportionate, awful and terrible hammering. I am glad to say that each of the lives lost was recognised and dignified by our coroner in Kildare, Professor Denis Cusack.

Some people have been vocal about avoiding an inquiry as they are anxious that blame not be attached, but an inquiry is not about blame - at least not for me. This was a novel virus, after all. However, it is about accountability and finding out exactly what happened so we can avoid it happening again. If we do not learn, we cannot prevent and avoid. In the first wave of the pandemic, 67 men and women in my constituency were transferred from hospitals without testing. That was entirely unacceptable, then and now. It was a grave error and omission that cannot happen again.

We need a radical rethink of our eldercare. Just like housing, the need for care when aged is left to the mercy of international wealth fund jackals. The fragility and care of our older people should not be profited from or privatised. Let us have an inquiry and find out the truth. Let us find out what happened so we can learn the lessons. Let this House honour our dead and all who loved and miss them.

I thank my party, Sinn Féin, for bringing forward this motion. Its main aim is to have a public inquiry set up into the deaths of over 2,000 of our elderly citizens who died in nursing homes during the Covid-19 pandemic. It would also protect and strengthen the rights, safety and dignity of residents in nursing homes, now and well into the future. The purpose of this motion is to put into legislation better mechanisms, better procedures and, most of all, better governance to make sure the mistakes and failures of the past will never happen again. This will be done by establishing an independent safeguarding authority; through mandatory reporting of suspected abuse, with full protection for the workers involved; and through full accountability at high levels, including mandatory penalties and criminal offences where a failure in care results in harm or hurt to residents.

The Health Protection and Surveillance Centre data show that 2,051 deaths were linked to clusters and outbreaks in nursing homes. One of the ways we can stop this from happening again is by delivering truth and justice to the families and friends of deceased loved ones and re-examining the flaws and mistakes of the past year. We know the virus acted differently in older people than it did in the general public. We know the supply of PPE was a major issue for staff and that restrictions on visits had a devastating effect on our older citizens, especially when they could not see their grandchildren, even through a window. A recent report from HIQA stated that the absence of clinical governance was one of the factors in Covid-19 evolving in nursing homes. We must learn from the past year and a half by creating a better and more robust system that has at its core the capability of coping with a modern-day pandemic, with residents and their carers at the heart of any such changes.

We pay tribute to all the managers and workers who carried on, despite being at times understaffed, bearing the risks to themselves and their families. They are the real heroes. I also offer our sympathies to all those who have lost loved ones as a result of this virus. I hope this motion will be accepted by all Deputies and that a public inquiry will follow as quickly as possible to alleviate the hurt and grievances endured by over 2,000 families, including having to bury their loved ones without proper ceremony or farewell.

I thank the Deputies for raising this important matter. The Covid-19 pandemic has led to an unprecedented challenge across our health services, nowhere more so than in our nursing homes. It has been an incredibly difficult time and we are all acutely aware of the huge sacrifices made by people living in nursing homes, their families and staff. It is fair to say that the health and safety of residents in nursing homes has been paramount in all our minds over the last 16 months.

Nursing homes are a key provider of care to older people in Ireland and over 30,000 of our citizens call them home. Those living in nursing homes are considered vulnerable to Covid-19 due to a variety of factors, including their age, underlying medical conditions, the extent of their requirement for direct care involving close physical contact, and the nature of living in congregated settings.

As well as this, learning arising from the pandemic to date has highlighted that Covid-19 is much more likely to be introduced into residential settings where there are high levels of Covid-19 in the community.

Over the course of the pandemic, restrictions to visiting in nursing homes have been necessary to reduce the risk of spread of infection and to protect residents who may be vulnerable to the virus. However, visiting is part of the normal daily functioning of nursing homes. Meaningful social contact is important to our well-being and is something that we have striven to provide as safely as possible.

In communicating with nursing home providers, I have continuously reiterated the need to ensure that visits take place to the greatest extent possible, in line with evolving visitation guidance, public health advice and risk assessments. Visiting under compassionate circumstances has been maintained under all levels of the Government’s framework during the pandemic. I have also encouraged providers to communicate frequently with residents and families about visiting and to respond to telephone calls by family members as much as possible, given the constraints that staff were working under.

Thankfully, Covid-19 cases and outbreaks in nursing homes are at a low level, largely due to the positive impact of the vaccination programme. I am pleased to be in a position to report that updated guidance on visiting in nursing homes comes into effect from next Monday, 19 July. This is a significant step forward to a return to more normalised visiting for people living in nursing homes and their families. Vigilance must be maintained, as we continue to deal with the risks associated with Covid-19, and visiting should continue in line with public health advice and the necessary infection prevention and control, IPC, measures.

In another positive development, significant regulatory reform is ongoing in conjunction with the Health Information and Quality Authority, HIQA, and is in line with the Covid-19 nursing homes expert panel’s recommendations and lessons learned from the pandemic. In April 2021, the Government agreed the progression of interim enhancements to the current regulatory framework for nursing homes, which will occur this year. These proposals aim to enhance the enforcement and oversight powers of the chief inspector of HIQA.

With regard to safeguarding issues, I assure the House that the Government takes matters and allegations of neglect and abuse seriously. There are various structures and processes available to protect against abuse and poor care standards, and to ensure prompt action, including through the independent ongoing regulation and inspection of nursing homes by HIQA. To this end, I met representatives of HIQA last Friday. Safeguarding adults at risk in the context of their interactions with the sector is a key objective of the Department of Health, every statutory body under its aegis and every health and social care service that interacts with such adults. Where abuse is a potentially criminal matter, it is the full expectation of the Department and me that any such instances in our health and social care services would be referred to An Garda Síochána in the first instance and investigated accordingly.

The Department is at an advanced stage in developing its national adult safeguarding policy for the health and social care sector. Extensive policy development work, including stakeholder engagement and detailed research, has been concluded. This includes service user focus group research and a major international evidence review, published earlier this year. Legislation to underpin this policy will be developed. A range of structures and processes has been established by the HSE to support and further develop its national operational safeguarding policy.

A key principle of safeguarding is that it is everyone’s business and that all healthcare professionals have key roles in the prevention and reporting of abuse. The essential role of social workers in safeguarding is recognised. The specialist safeguarding and protection teams in each of the nine HSE community healthcare organisation areas are managed and led by principal social workers and staffed by social work team leaders with professionally qualified social workers. These teams provide a range of safeguarding functions, from direct case management to quality assurance, as well as oversight and support to all service providers, including those funded by the HSE. Community support teams, as recommended by the nursing homes expert panel, will be implemented across each community healthcare organisation and each of these teams will have access to dedicated social worker resources through enhancements of existing community safeguarding teams.

As the House will be aware, nursing home providers are ultimately responsible for the safe care of their residents. Since 2009, HIQA is the statutory independent regulator in place for the nursing home sector, whether in a HSE-managed or a private nursing home. The authority, established under the Health Act 2007, has significant and wide-ranging powers up to and including withdrawing the registration of a nursing home facility, which means that it can no longer operate as a service provider.

The Covid-19 nursing homes expert panel made a substantial package of recommendations, which also reflects that systematic reform in the way nursing home care, and health and social care for older persons more broadly, are delivered and financed. Many of the short and medium-term recommendations have already been implemented. A number of these relate to the delivery of a broad suite of supports provided to private nursing homes, including free personal protection equipment, PPE; serial testing; HSE Covid-19 response teams; IPC measures and training; and temporary accommodation for staff. The significant examination undertaken by the expert panel provides important learning and a framework for enhancing older persons' services both in the short and long-term, and this work is progressing.

It must be recognised that the pandemic has not concluded. The ongoing management of the Covid-19 response remains a priority focus of the Government to ensure the positive gains being experienced are preserved and those most vulnerable to the virus continue to be safeguarded in light of the residual risk. This week, I met family members of people who sadly passed away in nursing homes. The Department is continuing to look at options which may be available to the State to listen to the voices of those who have lost a loved one. I conclude by expressing my sincere condolences to those who have lost a loved one during the pandemic.

I thank my colleague, Deputy Ó Murchú, for allowing me this time. The Minister of State knows about some of what happened in nursing homes last year. The reality of it has not sunk in properly with Government yet. I mention the pressure nursing homes were under when they were screaming for PPE and oxygen. That was the reality on the ground and patients continued to be transferred from hospitals without testing. The ambiguous guidelines that were provided for nursing homes and hospitals at the time led and added to this chaos. There were no GPs around at the time. GPs were just giving advice over the phone to nurses who were overrun in nursing home wards. These nurses were trying to take advice on a pandemic that we knew little about. There were no drips to give patients the medication that was needed. Patients with Alzheimer's disease were kicking and lashing out because they did not understand what was happening to their bodies and because medication could not be given to them.

Healthcare assistants were in the middle of all of this and many of them are now suffering from post-traumatic stress. We need to capture their testimonies for that to be placed on record and to change things that happened at the time. These are the selfsame healthcare assistants who are still on the minimum wage. We laud them and clap for them but they are still on the minimum wage, which is hard to believe. Some of them have over a decade's experience working in this sector.

Families need answers and the truth. They have been traumatised by the circumstances surrounding the deaths of their loved ones. The Government must conduct a public inquiry. I commend my colleague, Deputy Cullinane, on bringing this motion to the floor of the House. We need a full public inquiry into, and accountability for, the horrors that went on in nursing homes right across this State.

We in this State commend ourselves on actions we have taken to curtail the spread of the Covid-19 virus. However, the stark truth is that we have failed as a nation to protect the residents of nursing homes who are the most vulnerable people in our society. Residents of nursing homes have accounted for over 40% of all Covid-related deaths. The fact that over 2,000 people in nursing homes contracted the virus and died as a result is a damning indictment on the health service of this country. Many staff in nursing homes are to be commended on the work they did to ensure that nobody living in their establishment contracted the virus. However, unfortunately a number of nursing homes were asked by the HSE in their area to accept people from hospitals and were told the people being moved had tested negative for Covid and were, therefore, safe, only to be told a week later that some tests had come back positive. At that stage, the virus had spread among the residents of that particular nursing home. That is disgraceful and should never have been allowed to happen. There needs to be a full investigation into nursing home deaths due to Covid-19.

A nursing home, as its name indicates, is, in the first instance, a home for elderly people who are no longer able to live in their own homes and who require care and support. Everyone should feel safe in their own home. While I know that is not always the case, it should be for the residents of nursing homes. There are paid professionals in nursing homes to care for the residents. The lack of visitation allowed during the pandemic has led to concerns for the welfare of residents of nursing homes. The isolation, loneliness, mental health issues, neglect of care and occasional instances of abuse have gone undetected by family members and friends due to the fact that they could not visit their loved ones in nursing homes for a period of a year.

It is important that staff in nursing homes are mandated to report suspicions of neglect of residents, abuse of residents, or both, to An Garda Síochána and to safeguarding and protection teams. I am aware of members of staff who did the right thing, reported abuse of residents in nursing homes, only to be victimised or shunned by other staff as a result. That sort of attitude must change. It must become mandatory to report suspicion of neglect or abuse within the nursing home sector, as is the case in the educational system. There are national standards for adult safeguarding. There are policies on safeguarding. They need to be strengthened through legislation and a national authority for safeguarding must be established with clear guidelines on how and to whom neglect or abuse should be reported.

I am grateful for the opportunity to speak on this important motion. I support the calls that Care Champions have been making for a public inquiry into what happened in our nursing homes throughout the pandemic. We all know there were catastrophic failures in governance in our nursing homes. We saw very high levels of infectious disease and the sad loss of more than 2,000 people.

Staff were put into a nightmare situation where they were not given adequate supports and were left totally unprepared. Many of them also became sick and brought home the virus to their families. It was an extremely difficult situation for the families of those who were sick and those who died. Most people were unable to visit their family members to ensure they were being cared for properly or even to say goodbye.

It was clear from the very beginning that the sector needs widespread reform if vulnerable adults are to be cared for properly and to ensure that staff can work effectively in a safe environment. Many nursing homes found themselves completely unprepared and struggled to cope due to long-standing problems with chronic understaffing, poor governance and a lack of investment. The Government had privatised most of our nursing home sector and left them to it. We cannot wash our hands of our responsibility towards older generations in society. What we need is a full public inquiry into the scandal of nursing home neglect and deaths during the pandemic. We need to find out exactly what the failures were and how we can rectify matters to ensure that nothing like this can ever happen again.

We also need to listen to calls for the immediate improvements that families and advocates are calling for. Visitations, for example, are required to safeguard against neglect and isolation. As some nursing homes are still not complying with official guidance, this guidance needs to become law with enforcement powers for HIQA. We also need adult safeguarding legislation and an independent safeguarding authority needs to be created. The Government's response to this has been lacking so far, to put it nicely.

It can often be a difficult decision for families to put a relative into a nursing home or for individuals themselves to choose to go into one. However, many people prosper, have a renewed vigour and thrive in a nursing home environment. Nursing homes should be considered safe and secure places for the elderly where they receive the care and assistance vulnerable older people need and deserve. However, there were questions over the regulation and governance of nursing homes which were raised by HIQA prior to the pandemic. These concerns could have had a direct effect on the response by nursing homes to the ensuing pandemic. Of real concern is the lack of oversight of nursing homes. The pandemic has highlighted these concerns even more. Nursing homes should not be a barrier to family contact. Isolation is a great problem for the elderly in society in general and should not become a problem in nursing homes. This was the case as a consequence of the various lockdowns. The visiting restrictions imposed led to the very isolation feared by many elderly people and it has certainly led to a deterioration in the mental health and well-being of many elderly individuals.

Nursing home staff were at the front line of the pandemic from the very beginning. There was initially a slow response from the Government to implement measures and nursing homes did not have access to the personal protective equipment they urgently needed, leaving staff and residents vulnerable. This vulnerability was further exacerbated by the use of agency staff who were moving between different locations and the transfer of individuals from hospitals to nursing homes without testing. The lack of a proper mechanism and protection for staff in reporting instances of abuse and neglect needs to be urgently addressed. The lack of proper oversight for the sector could leave it vulnerable to a deterioration in standards and, ultimately, the care of residents. The concerns raised by me and by others over the course of the pandemic need to be urgently addressed. A public inquiry needs to be set up to establish the full facts and bring closure for the families who have lost loved ones.

I appreciate the opportunity to speak on this important motion. According to the Health Protection Surveillance Centre, more than 2,000 residents of nursing homes have passed away because of Covid-19, a number that accounts, in real terms, for over 40% of Covid deaths in Ireland to this point in time. This has been a massive issue in our society over the past year and a half. As the Minister of State and others have said, our thoughts are with those who are mourning the loss of their loved ones.

We must not forget that what might be described as a hands-off approach to nursing homes was to some degree prevalent at the start of the pandemic. HIQA provided the Department of Health with a list of what it described as nursing homes it believed would be at high risk at the beginning of the pandemic. What is even more concerning is that we do not know what follow-up the Department had with this list. Did the Department provide the list to NPHET in order that it could advise? It is clear that the Department of Health did not request that HIQA begin any preliminary assessments of these facilities, as no inspections were carried out at the beginning of the pandemic.

I agree that a public inquiry into these Covid-related deaths is required. It is now necessary. This is not the first time I have said that and I am not the only one who has said it in this Chamber, in the media and elsewhere. Many people require answers as to the State's interventions into the nursing home sector during the pandemic. I am calling again for a specific commission of inquiry under the Act into the circumstances of the deaths of 23 people in the Dealgan House Nursing Home, Dundalk. Each and every resident who died there was a mum, a dad, a grandparent, a much-loved aunt, uncle and friend. Their memories and human dignity insist that we know why and how they died.

Their families and loved ones have a right to know. Society has a right know. For well over a year, I and others have worked closely with bereaved, and by now, frankly, exhausted families, to try to piece together what happened more than 12 months ago at Dealgan House Nursing Home last March and April. Families, who have suffered enough, should not have to be charged with hunting down information through freedom of information requests to the HSE, the Department of Health and HIQA to try to establish what happened to their dead loved ones. We now know that Dealgan House Nursing Home was in chaos from at least early April 2020. We know that now but nobody informed the families. For the nursing home and the agencies, family members were an afterthought, if that.

Material secured by freedom of information requests and through parliamentary question replies to me and to others show massive staff shortages and absences, as a consequence of Covid-19, from 18 March. The picture on 6 April showed that at that stage, only six out of 22 nurses were available to lead the care of 84 residents. The director of the home wrote to the then Minister for Health, Deputy Harris, on 12 April stating that there was on occasion, "one nurse on night duty, dealing with 80 residents, some of whom are very ill". That illustrates the problem.

We know that HIQA was made aware of serious stuff shortages from 6 April.. Additional staff were provided by the HSE but too few initially. HIQA and the HSE, at the most senior level nationally and regionally, the then Minister for Health and the RCSI Hospitals Group were all aware of the grievous situation unfolding. All took some action, in time, but the fact is that we still do not know the full and unexpurgated truth about what happened at Dealgan House Nursing Home or in other care facilities.

Ultimately, many deaths later, in the context of Dealgan House Nursing Home, the RCSI Hospitals Group had to take operational control of the situation as it was so bad. This was an absolutely unprecedented move; a public hospital group taking full operational control of the management and operation of a private care facility. This is not normal in anyone's language.

In all our engagement with the HSE and the families, we still do not know with any certainty the threshold that was reached that prompted this unprecedented action. We need to know. Dealgan House Nursing Home is unique in that it was, and still is to the best of my knowledge, the only facility taken over by the State to ensure that the minimum standard of care could be provided to sick and vulnerable citizens when it could not provide the standard of care that was required and that should be demanded.

This demands our attention as lawmakers. It demand not just inquests from the coroner but a full commission of inquiry under the Act to shine a light and let the air in to get answers to the questions we all have, and ultimately, to understand what needs to change to make sure that what happened in Dealgan House Nursing Home will not be allowed to happen to anyone ever again, under any circumstances.

Nursing homes across the country are rightly concerned about the tapering of the temporary assistance payment. The decision to cut the level of financial support will have significant impacts on the money available to nursing homes that are still dealing with the impact and fallout of the Covid-19 crisis.

I note that in her closing remarks earlier, the Minister of State said, "The Department is continuing to look at options which may be available to the State to listen to the voices of those who have lost a loved one." In my view, that needs to be formal process. Absolutely, the voices of those who have been affected and those who lost loved ones need to be heard. That needs to be done formally and not by some kind of tokenistic exercise, well intentioned as it might be, to hear the stories of those who have lost loved ones. We need a full, formal investigation or commission of inquiry under the relevant Act to get to the bottom of what happened specifically in Dealgan House Nursing Home, and indeed, where the case arises elsewhere.

More than that, I believe the Minister of State will agree that we need a national conversation about elderly care. Older people have given much and continue to give much to our society. They have to be treated well and looked after. If this pandemic has taught us anything, it is that we need to flip the conversation on to how we can keep older people in their homes for longer.

We need to have a conversation about the model of care that is developed to look after the interests of older citizens into the future with dignity and confidence. It should be a respectful model of care with a range of different options they will have to choose from in terms of what works best for them and their families but primarily for them as citizens with rights whose dignity should be respected. That will mean investment in a public model of care.

What has happened over the past 20 years since the introduction of attractive tax breaks by the former Minister for Health and Children, Mary Harney, is that people with little interest in the care of older people, initially people who were working and investing in a range of different activities across this society and country, decided they would invest in private nursing homes. Effectively, the State co-opted out the care of our older citizens to these private companies, which by and large do not respect the rights of workers. We know about the low levels of pay and poor working conditions in the private nursing home sector and that it is particularly hostile to the organisation of trade unions, with which it should be working in the best interests of the staff and in developing good models of care for older people.

I am grateful for the opportunity to discuss this really important issue for many thousands of people across this country this afternoon. I look forward to the Minister coming forward as quickly as possible with proposals about how we can hear from the families in a formal way about their experiences. That should involve a formal commission of inquiry, specifically into the events in a nursing home in my constituency of Louth, namely, Dealgan House Nursing Home, but potentially widened out to other areas that also need the attention of this House to make sure we remember with dignity those who lost their lives and give them the dignity they deserve, and to make sure we can learn lessons about what happened over the last year or 18 months and apply them to developing a better, more inclusive and dignified model of care in the future.

I am glad to have the opportunity to speak in this important debate. I commend Sinn Féin on the detailed motion it has tabled. Much concern has been expressed about this issue over many years. Clearly, in the past 15 to 18 months, many of the shortcomings in elder care service were brought into tragic and stark relief due to the very high numbers of deaths that took place in our nursing homes. Some of those situations were highlighted in great detail in the recent "RTÉ Investigates" programme. I commend Mr. Barry O'Kelly on the work he did in that programme. There is no question but that the homes covered in that programme, as well as the whistleblowers who came forward and disclosed some of the awful practices that were going on in these nursing homes, require further investigation. There is a need for a public investigation into those particular nursing homes and into the allegations made by those whistleblowers. I have no doubt there are other nursing homes where similar bad practices existed, which resulted in tragedies for a number of the residents concerned.

This is, of course, an issue that we knew about. In many ways, it was a scandal waiting to happen. Was it really any huge surprise that there was such a high death level throughout the period when Covid-19 was raging? It was not really, when one considers how there was such light-touch regulation in this important care sector. That is something for which responsibility must be taken.

People have spoken about lessons that were learned and that need to be learned from the experience of the past 15 months or so with Covid-19. It has been said on umpteen occasions that there can be no going back to the old way of doing things.

There is no doubt that Covid has exposed huge weaknesses in how we provide public services. That applies right across the board, particularly to our health service but also to childcare and to the funding model for our education system. There are specific weaknesses with our provision of social care, whether that is in the context of people with special needs, the area of disability or that of elder care. The pandemic has exposed huge weaknesses in how services are provided, including the over-dependence on the private sector and the farming out of responsibility for what should be core social care services. We must stop that and go back to doing things in a different way. The State must take responsibility for the provision of those services and where they are not being provided directly and there is private involvement, there must be strong regulation.

Prior to last summer, after the first wave, I remember being struck by people talking about lessons that had been learned. I remember very clearly the then Taoiseach and current Tánaiste saying that we must find a new model of elder care. He was very specific about the matter and stated that we could not continue to provide older people's services in the way we were doing. He said that we must be much more creative, much more caring and must listen to what older people and their families want. Despite that, we are 12 months down the road and have seen the third tragic wave and the massive impact it had on older people. That wave took the lives of so many additional older people, caused so many tragedies within families and there is still nothing specific coming from Government about how to ensure that we do not have a repeat of what happened and that we provide services in a more person-centred and responsible manner.

There is no excuse for not learning lessons. This time last year the whole issue of older people's care, and nursing homes in particular, was examined in great detail, first, by the Special Committee on Covid-19 Response and, second, by the expert group on nursing home care established by Government. Their recommendations could not have been clearer. Last year, a very worthwhile submission was made by Sage Advocacy and there were written and oral submissions from that organisation to the special committee. At that time and since, there have been very strong cases made by Care Champions, yet we do not have that new model of care. There are three areas in particular that need urgent attention. The first relates to light-touch regulation, a feature of so many aspects of how we provide things in this country. Light-touch regulation of nursing home care has resulted in large numbers of tragedies and deaths and there is no denying that fact. HIQA, which is supposed to be the regulatory authority in charge of nursing homes, simply does not have the powers it needs to have in order to provide effective regulation. We know that last year HIQA said, "the current regulations need to be modernised and enhanced with additional powers and requirements".

Consider the detail of HIQA's powers. It must give notice of visitations and inspections, it must provide nursing homes with four weeks to respond and many things like that which are just far too weak. HIQA does not have the power to enforce staffing guidelines in the context of, for example, staffing ratios. That is just unbelievable. There are no staff-to-resident ratios in our nursing homes. Why is that the case? As a result of that to which I refer, there are no nurses on duty in many cases and there are large numbers of untrained and unqualified staff providing care and attention to out most vulnerable citizens. Why is that allowed to happen? It is a complete abdication of our responsibility for our most vulnerable people. We also know HIQA has called for safeguarding legislation. It said we must explore suitable structures and processes for external oversight of individual care concerns. Again, how long has this been going on? How long has the matter been with the Law Reform Commission? They were in before the health committee during the year and it does not look like there are going to be recommendations coming any time soon. This is another long-finger exercise.

The special committee made very clear recommendations on increased powers for HIQA, staffing ratios and safeguarding legislation. Those calls have been made and echoed by Sage Advocacy and Care Champions for some time. Care Champions wants HIQA's powers to intervene to be expanded. It wants an end to announced HIQA visits and greater accountability for the nursing home sector. It is asking for statutory staff-resident ratios in all nursing homes. It says we need an independent one-stop complaints mechanism for both private and public nursing homes. Of course, at the root of all this, including the light-touch regulation, is the fact that successive Governments have seen fit to privatise the elder care system. It is essential social care which should be an essential element of our publically-provided health service yet successive Governments have chosen to privatise it to the extent that 80% of nursing homes are private. Nursing home care is now regarded more as a good investment opportunity rather than an essential part of our social care system. Equally, the Irish Association of Social Workers has been very vocal on this. It is essential that social workers have the right to go into all nursing homes and address concerns and complaints that are raised and take those up. However, as of now there is a complete lack of clarity in relation to the role of social workers in safeguarding.

There can be no more excuses for this. All the recommendations and all the weakness are there in black and white from a number of sources. What we need now is action from Government and it cannot come too soon.

I will begin by offering the condolences of People Before Profit Deputies to all who lost loved ones during the pandemic, but particularly those who lost loved ones in care home settings. I thank Sinn Féin for bringing forward the motion, but there should be no deed for it. I refer back to the text of two critically important recommendations People Before Profit secured in the Final Report of the Special Committee on Covid-19 Response. That report was published ten months ago in October 2020. The first recommendation reads:

That a public inquiry be established to investigate and report on all circumstances relating to each individual death from Covid-19 in nursing homes. Draft terms of reference should be presented for consideration by the Joint Committee on Health by the end of 2020.

Many of us in this House worked for hours and hours on the special committee and its key recommendation did not even see the light of day at the Joint Committee on Health. It was a recommendation we in People Before Profit were adamant about including in the committee's report. The public is still clamouring for that inquiry and the demand is being voiced week after week in the national media. We all know that the "Prime Time Investigates" report showed many of the harrowing accounts of those who died from Covid in nursing homes. Calls for public inquiries came from all sorts of parties, many of them very diverse. They included the Coroners Society of Ireland and the Irish Association of Social Workers. As the Joint Committee on Health has not presented the terms of reference within the time frame recommended, I am returning to the demand for a public inquiry from the special committee as a matter of urgency and fully back this motion. Specifically, I am requesting that a report be prepared on the Government's failure to implement this first and most crucial recommendation of the special committee on Covid-19. The timescale for moving to implement this recommendation has gone beyond urgent.

I will also be seeking the report for the Government's failure to implement the second recommendation People Before Profit had listed on the special committee's report.

It states:

A review shall be undertaken into the impact of privatisation on Ireland's nursing home sector and to ascertain its impact on:

- nursing levels,

- expertise and qualifications of staff,

- medical and other facilities available in older people's care settings as a result of the policy decisions by previous administrations to incentivise private care settings, resulting in 80% of residential care being provided in the private sector, and

- the adequacy of funding to deliver optimal outcomes.

We sought the review into the impact of privatisation because we refuse to be deflected from the significance of the single most momentous change to have taken place in the care of our vulnerable older people in recent decades. That is the wholesale privatisation of that sector, leaving a position where 80% of the care of vulnerable older people in need of long-term residential care was handed over to the for-profit sector.

In the private nursing home sector that HIQA selected for particular mention in a report last July, it mentioned "very limited clinical oversight of most nursing homes, particularly those in the private sector". I remind Members that private nursing home sectors continue to operate without an acceptable degree of financial transparency. In its report of August 2020, the Covid-19 nursing homes expert panel was clear on the need for greater financial transparency. The State's contribution was over €1 billion via the nursing home support scheme in 2019 and the contribution from the owners of private nursing homes - especially that of larger consortia - remains unknown.

The panel stated that funding and expenditure specifically invested by providers requires greater transparency. This should be noted when there are any changes to the contribution that older people are expected to make, either through their accessible income or assets, to long-term residential care. There must be acknowledgement of how the private sector operates and derives benefits from the scheme. For that reason, we will push for a return to the recommended review into the impact of privatisation on nursing home care.

I will return to an alarming report from HIQA sent to the Special Committee on Covid-19 Response in September 2020. Among other alarming issues, it indicated in the private nursing homes sector an absence of clinical governance, inadequate staffing levels and unavailable contingency plans in the event of sudden and unplanned absences. Resources such as personal protective equipment and access to specialised care and support were lacking and the layout of centres had an effect on the ability to separate healthy and ill residents or isolate ill residents as required. There was also a history of non-compliance with key regulations, such as governance, management of premises and infection control.

The manner in which the pandemic has affected nursing homes obliges us to confront the manner in which we have allowed long-term care of vulnerable older people to evolve in Ireland. There have been very deliberate and highly ideological policy decisions underwriting that evolution. The trauma caused by the Government, its agencies and the nursing home sector should not blind us to the questions we are obliged to pursue relating to the deaths that have occurred in nursing home settings in Ireland.

Some of the stark figures were presented by Sage Advocacy and Age Action Ireland, which demonstrated to us that in July last year, 56% of all Covid-19 deaths took place in nursing homes, a setting where only 0.65% of the population lives. The HIQA report called on nursing homes in Ireland to be investigated but the authority indicated it was not in a position to have a physical presence in nursing homes during the pandemic. The fact remains that most of HIQA's inspectors did not conduct risk inspections in those nursing homes when an increasing number developed Covid-19 outbreaks.

The families of those who lost their lives in these nursing homes must know exactly what happened to loved ones. A lack of communication from nursing homes was a common thread among many of the concerns expressed. There were unanswered phone calls or queries, causing immense anxiety and worry for concerned relatives and friends, particularly in the cases of nursing homes where severe outbreaks were reported. That immense distress and those unanswered questions persist for those who lost relatives and a public inquiry that could provide answers to some of those questions is the very least that the Government owes these families.

The Minister of State, Deputy Butler, is reported in the Irish Examiner this evening as saying she plans to report any potentially criminal allegations involving abuse and neglect in nursing homes to the Garda. She repeated the point in her speech. As the Minister of State knows, potential abuse and neglect in HSE nursing homes are already automatically referred both to the Garda and registered safeguarding social workers. I therefore have a question for her. Is it now intended to change the law so this would automatically be the case in privately owned nursing homes?

The interview in the Irish Examiner cannot just be about being seen to do something on a day when the Dáil debates a motion that highlights the Government's inaction. It cannot be an excuse for further inaction. In that regard, I ask if the Government will legislate to allow trained and professional safeguarding social workers to make unannounced visits to all nursing homes. Nursing homes were closed institutions for most of the pandemic and closed even to relatives much of the time. The history of closed institutions in this State is, in general, not something of which to be proud, particularly when it comes to the protection of people who have effectively been locked in. Giving social workers the legal right to make unannounced visits is a simple and practical way to improve safeguarding in our nursing homes.

I specifically say "our nursing homes" but they are not really ours. Once upon a time, they were ours, but that was before the programme of privatisation pushed by successive Fianna Fáil and Fine Gael-led Governments. Today, 80% of nursing homes are privately owned and run for profit. The for-profit nursing home model did not perform well during the Covid-19 crisis. I strongly support the idea that the privatisation process should be reversed and the nursing home sector should be taken into public ownership before being fully integrated into the public health system.

In her interview with the Irish Examiner, the Minister of State was also quoted as saying she favours shorter inquiries rather than a national inquiry. Will she confirm that she was quoted correctly? If she was, she is the first Minister or Minister of State to voice clear support for an inquiry or inquiries of some kind or other. Will she clarify that point? I have no issue with local inquiries but the demand may be so great, we will end up with a national inquiry, in effect, in any case. I will vote for the national inquiry proposal tomorrow.

I thank Sinn Féin for moving this motion, which gives us the opportunity to discuss the impact of Covid-19 on nursing homes. There has been repeated reference in recent months to the nursing homes scandal, which became evident during our response to Covid-19. We have heard the number of deaths and, as Deputies have stated, over 2,000 nursing home residents are considered to be in the Covid-19 death category, and that is approximately 40% of all Covid-related deaths in Ireland.

We do not seem to have any specific details on what happened in the various nursing home settings and how Government policy may have played a role in making that problem worse. This motion calls for a full public inquiry into nursing home deaths. I am sure when we have contact with constituents, we all hear various versions of similarly sad or heartbreaking stories of vulnerable people in our nursing homes. We need answers.

The statistics and stories indicate there is a need for a full public inquiry. What really needs to be established is the extent to which the decisions of authorities resulted in extra and avoidable Covid-related deaths. To what extent were nursing home patients denied treatment that would have resulted in their recovery and to what extent were "do not resuscitate" orders used when nursing home residents were in hospital?

We had reports over a year ago of patients being discharged from hospital with Covid-19 and going back to nursing homes, leading to major Covid-19 outbreaks in nursing homes. We were conducting thousands of Covid-19 tests per day on healthy people but the authorities did not have a system in place to test vulnerable and non-healthy people before being discharged from hospital and allowed back to a nursing home. All of the young, healthy people in this country were persuaded that they needed to remain locked up in their homes in order to protect vulnerable people but meanwhile, it seems, these vulnerable people were being neglected by the same people who were telling young people they had a moral duty to stay at home.

I am concerned about the proposal in this motion to put visitation guidance on a statutory footing. It may be the case that in some areas such regulation of nursing homes may be insufficient but I would be fearful of what the visitation guidance referred to in the motion might look like when implemented. We do not want to create a scenario where a husband and wife, perhaps having their final embrace, are subject to a HIQA representative standing over them with a clipboard and a stopwatch, or where no exceptions can be made for individual cases. More fundamentally, do we really want this House to decide when a husband can visit his wife in a nursing home and under what conditions? Do we really want to be deciding or be dictating to a child when he or she can see a parent. Making visitation guidelines into laws would be an overreach of the State. I have grave concerns about that.

The motion also calls for the mandated reporting of abuse and neglect of residents by nursing home staff. It is very hard to understand how this is not already mandated regardless of whether this motion as a whole is passed or not. I hope that the Minister is listening and will take the necessary steps to introduce and mandate reporting of abuse and neglect without delay.

Finally, the motion calls for accountability at organisational level. As an elected politician, it is my experience that our attitude to accountability leaves a lot to be desired. Yes, I do believe that the motion is correct in calling for the introduction of accountability at an organisational level with regard to penalties and criminal offences, where failures to govern safely in accordance with HIQA regulations result in the loss of health or life for residents, in the case of that service. It is not only at an organisational level that such accountability should exist. Those making the policy decisions should also be accountable.

I also want to voice my utter dismay at the abandonment of nursing homes with the stopping of the temporary assistance payment scheme. Not extending it in line with the other supports says it all.

I welcome the opportunity to speak. I thank those responsible for bringing this motion before House and for giving all Members an opportunity to debate it. The motion calls on the Government to take action on a number of items and I will deal with these individually.

The motion calls on the Government to commence a full public inquiry into the deaths of residents, into the quality of care in nursing homes during the Covid-19 pandemic and into the systemic failures in the sector during that dreadful period. I would like to put on record that I will support any motion that calls for a full public inquiry into nursing homes and their responses to the Covid 19 pandemic. We must, however, be very careful. This must not turn into a witch hunt against any nursing home and must be focused on all nursing homes and their responses. Not only must we look at how nursing homes responded we must also look at how the HSE, HIQA and other State bodies reacted. It would not be fair simply to target the nursing homes and not take into account how State bodies intervened and assisted the sector at this time.

A full public inquiry must be open and transparent and take into account the views of everybody concerned. I know from speaking to the families of many of those who sadly passed away that there are many unanswered questions. The families have a right to ask these questions. It is the very least they deserve.

This must not be a witch hunt against any single nursing home. The bottom line is that we must learn from the dreadful period when Covid-19 inflicted so much death and heartbreak to the residents of nursing homes. We must identify where the systems broke down. We must identify where supports are needed to ensure that we have robust systems in place that will prevent this happening again in the future.

As I said earlier, the families who lost loved ones in nursing homes during this period have many unanswered questions. They should be part of any public inquiry. Their experiences must be heard and documented. Only by hearing their experiences can we learn, and learn we must. We must ensure that this never happens again. It is the very least that not only the families affected deserve but also the residents and staff of the many nursing homes around the country.

It is my view that nursing homes do not become bad overnight. In my experience I have some very good memories of nursing homes and the care they give. My mother spent the last three years of her life in Dealgan House nursing home in Dundalk. I could not have asked for a better place for my mother to spend those last three years. She was treated with great professional care by all the staff.

It is important to remember that, just like the HSE, the vast majority of the nursing and care staff in nursing homes are professional people who have dedicated their working lives to care for others. I would not like to see a public inquiry as a witch hunt of these people. Once again I stress that we must be very careful and not have a situation where a public inquiry simply becomes a platform to attack nursing homes. It must be open, fair and transparent. It must identify where the system failed and put in place recommendations that will ensure this never happens again.

The motion also calls for the placing of long-term residential care facility visitation guidance onto a statutory footing and to give interim authority to HIQA to enforce it. Again, in principle I agree that we do need to give this a statutory footing although I would be concerned that interim authority be given to HIQA. I believe a public inquiry will answer a lot of the questions and provide a solution to this.

The motion also calls for the Government to expedite adult safeguarding legislation and I support this call. In addition, the motion calls on the Government to ensure that all residents are treated as community clients with direct access to safeguarding social care services and all primary care services, which would include an independent social worker liaison attached to each Covid-19 cluster in long-term residential care facilities. In principle I agree with this but I urge caution in how we approach this. As I said, I genuinely believe that a full public inquiry into how the nursing homes dealt with the pandemic will provide many of the answers including putting in place the necessary safeguards for residents.

I broadly support the motion and thank those for bringing it to the House. We must be careful, however, to ensure that it does not become a public witch hunt against individual nursing homes. The families of those who so sadly lost their lives in nursing homes during this pandemic have many questions and these must be addressed and answers given. We must ensure that the scale of this never happens again and a full public inquiry that will investigate all sides of this is the only answer. We must find out where the systems broke down and put in place measures that will ensure this never happens again.

In her speech the Minister of State, Deputy Butler, said that she met with families this week and over the past weeks whose family members passed away in nursing homes. The Minister of State said that her Department will continue to talk with these families and to listen to these voices. This is very important. People have lost loved ones and they want to get their say. They want investigations and I believe that the Minister of State will do this.

I thank Sinn Féin very sincerely for bringing forward this very important motion. At the very beginning, I must say to all the families who very sadly lost loved persons and loved family members and relatives in nursing homes, or indeed anyhow during the pandemic, we have to sympathise with them this evening. It would be wrong and neglectful not to do so at the very start of every contribution, and to pray for those people who left because of this illness and whose time in this world was cut short. For that we are tremendously sorry.

Many private nursing home operators who account for four in every five nursing homes in the sector felt that they were abandoned during the public health response in the first wave of the pandemic. The Coroners' Society of Ireland has rightfully called for a wide-ranging inquiry into all Covid-19 deaths in nursing homes. There are many other information gaps that must be filled. Of course there are questions that must be answered and of course it is right to highlight that here tonight during this debate, but we must also highlight the excellent nursing homes that run great houses and that take great care of the people in their charge and in their care, and I want to do that on behalf of the nursing homes I represent in County Kerry. Those nursing homes went to extraordinary lengths during the pandemic. I know many of the workers in these nursing homes. The best way I could describe it is that they slaved night and day to ensure the safety and the well-being of the people in their care. These workers in the catering sections, the nursing sections and in the maintenance of the nursing homes all did Trojan work. Only for their efforts, and only for the nursing homes that were successful in keeping the virus out, the situation would have been way worse.

First, we must look at where there were problems or mistakes or where things went wrong. We must also look at where things went right. I publicly thank the management, workers and staff of every nursing home in my county. I thank them most sincerely for protecting and helping to mind older people, our friends and relatives.

I too sympathise with the families who have lost loved ones throughout the pandemic. What were the problems and what can we learn from the situation? I have seen nursing homes that lost 37 staff during the pandemic in a two-month timeframe because they were poached by the HSE. When the HSE offered positions, including through agencies, it almost crippled nursing homes that had been providing good care. It took 37 staff from one nursing home. The nursing home then had an issue down the line with providing adequate staff during Covid. There are questions to be answered in that regard.

Nursing homes in Limerick have gone above and beyond the duty of care for the people who lived in them. In one case, where a husband and wife were both in a nursing home, their children could not get see their mother because she was upstairs, but they could see their father through a window. When their father died, their mother could not get to see her husband.

Untold damage has been done due to a policy not being put in place, not only in nursing homes but also for those who brought children into the world, to ensure visitation rights for people. There will be a knock-on effect from that in years to come. We must ensure that this never happens again, no matter what arises. Families must be able to see their loved ones and family members no matter what the circumstances. Precautions must be taken for the protection of all. The HSE has a big question to answer in this regard as well.

I welcome this excellent motion on the need for the Government to begin a full public inquiry into the scandal of the neglect and deaths in nursing during the Covid-19 pandemic. Some community hospitals must also be brought into this public inquiry.

At the outset, it is important to commend the many nursing home staff who worked hard under considerable pressure and stress, as well with as a lack of resources during the pandemic, to do their best to look after those in their care. However, it is clear that the sector as a whole was unable to cope effectively due to the chronic understaffing, weak governance arrangements, poor safeguarding provisions and a lack of investment.

The Coronavirus-related deaths of more than 2,000 people in nursing homes reflects an abject failure of policy and oversight by successive health Ministers and the agencies they oversee. Prior to the pandemic, fatal flaws were exposed in the health system and social care services. Many nursing homes and some community hospitals were unprepared for an outbreak of infectious disease. The consequences were devastating for families who lost more than 2,000 relatives in these institutions alone.

Given the shocking magnitude of this situation, I fully endorse and support the establishment of a commission of investigation or an alternative form of public inquiry into the handling of Covid-19 in long-term care facilities. Such an inquiry should be efficient and time-bound and interact actively with the families who lost loved ones in nursing homes during the pandemic. The scale of the deaths that occurred in care homes during the pandemic is truly unprecedented. It is a dire reflection of the state of Ireland's health services and the lack of adequate resources available.

Were community hospitals and nursing homes up to HIQA standards that were set by various Governments? Scandalously, they were not. Unfortunately, I know for a fact that was the situation in west Cork. It has done untold damage to families in my constituency. Previous Ministers have questions to answer, not, in fairness, the two Ministers of State who are present, Deputies Butler and Rabbitte. More than 2,000 elderly people lost their lives.

Now the grants have been withdrawn from nursing homes, which is another scandal. On the one hand, we are told people cannot go into a restaurant or a pub because of the danger, yet on the other hand, health staff are being withdrawn to make sure that they do not get the virus in nursing homes.

The coronavirus-related deaths of more than 2,000 people in Irish nursing homes reflects an abject failure of policy and oversight by successive health Ministers and the agencies they oversee.

Prior to the pandemic and illuminated again at the very beginning of the pandemic, fatal flaws were exposed in our health and social care services. Many nursing homes were unprepared for any infectious disease outbreak and the consequences were devastating for the families that have lost more than 2,000 relatives in these institutions alone. One death is one too many, but that number is shocking.

At the outset, it is important to commend the many nursing home staff and management who worked hard under considerable pressure, lack of resources and stress during the pandemic to do their best to look after those in their care. However, it is clear that the sector as a whole was not fit for purpose. That is not its fault. The HSE diverted PPE equipment away from the sector, such as valuable oxygen supplies.

The Government should apologise for the needless deaths as a direct result of its policies and lack of investment. Additionally, a full-scale investigation must be undertaken to ensure such a disgraceful situation never occurs again. I am truly flabbergasted that no systemic analysis of safeguarding practice and trends in the sector took place during the pandemic. I tabled a question to the Minister for Health today and I raised this issue with him as well.

I support Sinn Féin's motion. An independent investigation should include a cost-benefit analysis of the Government-imposed lockdowns to date. I refer to the overall costs of the lockdown in the mental health area due to delayed diagnosis and missed diagnosis. The impact on all the services together is shocking, as well as the impact on the community, but the community does not matter; it is lives that matter. People died alone. Ireland had the longest lockdown in the world and the second highest rate of nursing home deaths. It is appalling. I do not blame the staff. We know that 50% of the patients who died were infected in 575 nursing home buildings and 15% of deaths were due to infection in hospital buildings. When we send someone to a nursing home, we talk with people and we check the area. I know that staff do their best, but we expect our loved ones to be safe above anything else and that they will not get infected or die as a result of something they pick up in a hospital or nursing home. A thorough and full investigation must be carried out to ensure that this can never happen again and that we learn from our mistakes. When we look back on it as history, it will be considered a tragedy, but I hope we can learn from it.

This motion from Sinn Féin, which I fully support, calls for a full public inquiry into the deaths of residents and the quality of care in nursing homes during the Covid-19 pandemic. The purpose of any public inquiry is to establish the facts in regard to the specific circumstances. Those circumstances include the fact that more than 2,000 nursing home residents have died due to Covid-19. That means more than 40% of Covid-19 related deaths occurred in nursing homes.

Those facts, along with the many different media exposés of totally inadequate care, neglect and, in some cases, abuse of residents, certainly make the case for a public inquiry. We must establish the facts. We must look at the context and evaluate the role of the many actors involved in the care of people in nursing homes. That includes the HSE and its response. It includes the management and staff of nursing homes. It also includes the supports that were provided or not provided by the various State actors. It includes the role of HIQA.

It includes the role of hospitals in discharging persons back to nursing homes and-or the protocols around patients from nursing homes with Covid-19 accessing acute hospital services.

I wish to clearly state that I am not pointing the finger of blame at any group, sector or individual. The purpose of a public inquiry would be to establish responsibility. It would not be to prejudge or make assumptions about the public or private sector, but to consider the evidence and only then arrive at conclusions. Having held such an inquiry, we would then need to put legislation in place to ensure proper adult safeguarding. All residents should have direct access to safeguarding social work services and all primary care services. I agree with the report, which states that HIQA must be empowered to oversee and enforce safeguarding legislation. There also needs to be a legal right of entry and powers of investigation for the appropriate authorities.

Care Champions have reported more than 500 serious safeguarding concerns in nursing homes over the past 14 months. They emphasise that not all nursing homes are negligent, but some are, and that is what we are highlighting tonight. I have received substantial documentation from bereaved families of the Ballynoe nursing home United for Justice group. They outline their key concerns, of which there are many, including a lack of infection control, serious neglect of residents, a lack of adequately trained staff and minimal communication with families during the Covid outbreak. In truth, it is hard to read, but for the residents and their families, it was a terrible time. Perhaps the most powerful point in the documentation that the group sent to me is where the families say that a public inquiry and HIQA investigation would not just be for them, but for the other families around Ireland who were looking for answers. It is also needed for the safety and well-being of nursing home residents in future.

Another important element of this motion is how it would place long-term residential care facility visitation guidance - I emphasise the word "guidance" - on a statutory footing and give interim authority to HIQA to enforce it.

Of all the emails about Covid that I received as a public representative during the pandemic, the most heart-rending were from family members who could not visit for months on end and, in some cases, whose loved ones died as they watched through the windows. I am not minimising the challenges faced by those who manage nursing homes. Those challenges were significant and, in some cases, it was a matter of life and death. However, if we had visitation guidance - I again emphasise "guidance", not definitive rules and requirements, as we could not have those - on a statutory footing, there would be some clarity. It would take some of the awful responsibility off the shoulders of management at some nursing homes.

For all of us receiving emails and phone calls, the pain, grief and unanswered questions of so many families cannot be ignored. This motion contains many proposals that would help to answer a number of those questions. It contains other proposals that, if implemented, would help to safeguard some of our most vulnerable people in long-term care.

Before I finish, I wish to emphasise that many nursing homes and staff gave their all during the pandemic. They left no stone unturned in trying to protect their residents - their families, which is how they viewed them. I spoke to many of them during the pandemic as they struggled to ensure the best possible outcomes, be that through sourcing proper PPE or ensuring sufficient staffing levels. Many Deputies have spoken about the challenges nursing homes faced in this regard. People also tried to ensure access to acute hospital care where needed. Many staff and managers had sleepless nights and long days while trying to manage during the pandemic. Very few people in this Chamber would want to exchange places with them, given what they went through day in and day out. Tonight, we are speaking in a wider context and of the need for a public inquiry and subsequent legislation where appropriate, but it is important to recognise the reality of what happened, the good with the bad and the bad with the good.

I have raised the issue of the discontinuation of the temporary assistance payment scheme, TAPS, to nursing homes. As the Ministers of State will be aware, every cent that is spent is itemised and accounted for. In my view and that of many in the nursing home sector, that money is still necessary in order to continue protecting residents and workers.

We are still awaiting a report on the proper funding of nursing homes. It is essential, as we cannot deal with one part of the problem while ignoring the rest. Nursing homes need to be resourced properly. The Covid-19 pandemic has cruelly exposed the fact that some need urgent investment. In the context of this debate, though, I support the call for a public inquiry while recognising the significant efforts made by many to protect our vulnerable people in nursing homes.

I thank the Deputies for their valuable comments on this motion. The debate has been useful and will be of great benefit as the Department continues to progress proposals to enhance and improve services for older persons further.

I will pick up on a small, but key point made by Deputy Harkin that needs to be addressed by the Minister of State, Deputy Butler, and me. It has to do with recognising the valuable work and sleepless nights of nursing home owners and staff throughout Covid and the 100% they gave. It was not just staff and managers who had sleepless nights - the Ministers and Ministers of State who held those portfolios worked endlessly to ensure that supports could be put in place. We may have different views on how that can be best achieved, but we all want the same result, namely, ensuring that older people have access to safe, high-quality and effective care.

As the House will be aware, the Covid-19 nursing homes expert panel, which was established last year, provided a comprehensive report and package of recommendations regarding the ongoing response to Covid-19 and the longer term strategic reform of older persons care. Many of the short- and medium-term recommendations have already been implemented. Continued learning and understanding of the progression of the disease in Ireland is an integral part of these recommendations.

There have been various examinations and reports with a focus on Covid-19, its impact on nursing homes and the lessons from the pandemic that can inform future policy, regulation and the model of care for older persons.

There has been a clear national commitment to continue to learn from the pandemic as the national and international understanding of the virus evolves and, where necessary, to ensure that the public health-led approach evolves as evidence and learning materialises. The findings of these reports confirm that the infectious nature of Covid-19 makes it difficult to prevent and control in residential care settings. As mentioned by the Minister of State, Deputy Butler, Covid-19 is more likely to be introduced in residential settings where there are high levels of Covid-19 in the community.

In order to mitigate against these risks, the State has put in place a comprehensive set of public health measures, actions and responses to support nursing homes. Sustained communication and inter-agency co-operation remain central to the response to Covid-19 across the HSE, the National Treatment Purchase Fund, NTPF, HIQA and the Department. Guidance, PPE, staffing, serial testing, infection prevention and control training, accommodation and financial support have been provided to the nursing home sector, both public and private. In addition, multidisciplinary clinical supports are in place at community healthcare organisation, CHO, level through 23 Covid-19 response teams.

I again assure the House that adult safeguarding is a matter of paramount importance for all of society, including all Government agencies and Departments. The safety and protection of adults at risk of abuse or harm by others is a fundamental priority for the health and social care sector. A strong focus has been placed on adult safeguarding within the health sector, especially in recent years. In the health sector, a framework of standards, policies and procedures for safeguarding of adults who may be at risk of abuse, harm and exploitation in health settings is in place and further measures are being developed to strengthen this framework.

The Health Information and Quality Authority is the statutory independent regulator in place for the nursing home sector, whether it is a HSE-managed or private nursing home. This responsibility is underpinned by a comprehensive quality framework comprising registration regulations, care and welfare regulations and national quality standards. HIQA, in discharging its duties, determines, through examination of all information available to it which includes site inspections, whether a nursing homes meets the regulations in order to achieve and maintain its registration status. If a nursing home is deemed to be non-compliant with the regulations and the national quality standards, it may either fail to achieve or lose its registration status. In addition, the chief inspector has wide discretion in deciding whether to impose conditions of registration on nursing homes.

Another important point raised by the Deputies is that of visiting. People living in nursing homes and other long-term residential care facilities had limited opportunities to welcome visitors for a period of time. This was an unfortunate but necessary measure to help protect residents and reduce the spread of the virus. However, as the Minister of State, Deputy Butler, said, following many incremental changes to the level of visiting that could be facilitated, we are expecting nursing homes to begin the return to normal visiting from next week. This is a welcome development and a positive indicator of the benefits that older people in nursing homes are experiencing as a result of the vaccination programme.

It is commendable that our colleagues across government and the House are committed to working towards safer care for older people. It is acknowledged there are aspects of older persons services that require improvement. In line with the programme for Government commitment, we will work to ensure the best possible safeguards are in place to protect our friends and family in nursing homes.

I will recap on some of the comments made by the Minister of State, Deputy Butler, and reiterate that enormous work has been undertaken to improve our older persons services. A comprehensive package of policy responses and support measures was developed and implemented to support nursing homes throughout the pandemic. Significant progress has been made on implementing the important recommendations of the nursing home expert panel. A third progress report on the implementation of the panel’s recommendations is being finalised. It notes the following developments. The IPC link practitioner programme framework has been finalised and phased implementation commenced in March 2021. Phase 3 of the safe staffing and skill mix framework commenced in August 2020. Phase 3 includes three distinct stages, the first of which will focus on nursing homes. A national task force, with representation from key stakeholders and agencies, has been established by the Minister to develop a framework for safe staffing and skill mix in long-term residential care settings for older persons. Funding has been provided to extend the research contract supporting the development of a framework for safe nurse staffing and skill mix across various areas for another three years. The HSE Covid-19 teams remain in place and continue to actively support prevention, preparedness and management of outbreaks, irrespective of whether facilities are operated by public, private or voluntary providers. In parallel, work is under way to progress the establishment of community support teams.

As the Minister of State, Deputy Butler, outlined, a range of legislative proposals is being brought forward which will enhance the governance and oversight of nursing homes and improve the reporting of key operational data. All of these positive developments, in addition to the wider reform of older persons services, will increase safety and oversight in the nursing home sector.

We know that people living in Ireland are living longer than ever before and we must ensure they live and age well. Therefore, it is clear that continued investment in our services for older people, including home care, is vital. The overarching policy of the Government is to support older people to live with dignity and independence in their own homes and communities for as long as possible. The continued development of a new statutory scheme for the financing and regulation of home support services is a key enabler towards achieving this aim.

The pilot of a reformed model of service delivery for home supports is due to commence this year. The Government has made improved access to home support services a priority. This is reflected in the unprecedented level of investment, secured by the Minister of State, Deputy Butler, for these services in budget 2021. Some 5 million additional home support hours will be provided for in communities throughout Ireland this year. Some €632 million was allocated in funding in 2021 and will provide for a total of 24 million hours of home support. The increased investment will contribute to meeting the programme for Government commitment to providing equitable access to home support services. There has been a significant reduction in the number of people assessed and waiting on funding for home support throughout 2020 and into 2021, with additional hours being delivered.

I look forward to supporting the significant work which is in train to further improve older persons services. I thank the Members once again for the opportunity to speak on this matter. I express my sympathies to the families who have lost loved ones during Covid-19.

The motion calls for a public inquiry into the deaths of people in nursing homes during Covid-19, including the quality of care that was provided. I am conscious there has to be balance found here. Nursing home staff have been under severe pressure and resources are probably also a factor. The Irish Association of Social Workers and the bereaved families of residents of the Ballynoe nursing home in Glanmire are also calling for a public inquiry. The inquiry must get answers to the families' questions on the lack of infection control, serious neglect of residents, staff calls for help to the HSE Covid-19 response team not resulting in any additional supports, lack of nutritional fluids and residents being left for hours on end during the Covid-19 outbreak. The list goes on and on. This is a very worrying issue and excuses will not wear well with the people who need answers for those they have lost.

I am calling on Deputies across the House to support the motion. We need clarity for these people. We must ensure this never happens again. That is one of the most important points here.

I pay homage to the staff and families who did their best in extreme difficulty. Unfortunately, sometimes the best is not enough.

Last week, we were discussing another centre in my home town, the Owenacurra Health Centre, which has never had a Covid-19 case. In that context, we have to congratulate people as well.

I urge the Government to support Deputy Cullinane's motion, support all of us, support the families who have lost loved ones and also to support the staff in these nursing homes, and their families, so we can emerge with a proper result. However, it must be clear, adequate and solid. People need real answers. People have to be accountable and responsible for this as well. My final call is for the House to support this motion.

This motion calls for a public inquiry into what happened in nursing homes. We all accept that there were failings by the State and other factors that have to be investigated. There are lessons that we have to understand and then there are actions that we have to implement. All of us offer our condolences to the families who have been through absolutely abject tragedy. We also show solidarity with those people who have worked through very difficult periods and did all they could in nursing homes, but the question remains. There were failings and the State has had major failings. A number of reports have been produced in the past while and we know there are actions to follow from them. We must ensure that happens.

Deputy Cullinane has also asked that we get the safeguarding aspects and the framework correct and that we have social care teams front and centre. HIQA is on record as stating that it does not have the powers that are required to carry out the regulatory job it has to do. All these parts need to be put in place because, at this point in time, we are failing to look after elderly people in the community. It is just not good enough, so we have to take action. It is absolutely necessary.

I doubt that the Ministers of State will be shocked when I raise, once again, the issue of Dealgan House Nursing Home, the absolute tragedy that over 20 people lost their lives and the families who were detrimentally impacted by this at the beginning of the pandemic. The Minister and the Minister of State, Deputy Butler, met the families. The Minister stated that they need a mechanism to allow them to get answers. The families are making freedom of information requests and putting forward parliamentary questions from some Deputies, including me. They are meeting the HSE and the RCSI Hospitals Group. They are carrying out an investigation on their own. That is not good enough. I accept that there is a disputed narrative, but the only means of getting to the truth is to have a full public inquiry. It is not enough for the Department of Health to set up a mechanism for grieving families to have somebody to talk to. There must be full investigative powers. I commend the motion to the House.

I will start by offering my condolences to all the families who lost loved ones in nursing homes and, indeed, to people who lost loved ones over the course of the pandemic to Covid-19 outside nursing homes. This has been a very difficult time for everybody. I do not dispute the fact that all Members of the House, be they in the Government or in the Opposition, want to ensure there are the best levels of care for older people and that we do our best to ensure that whether somebody is in a public nursing home, a private nursing home or being cared for in his or her home those people have the highest levels of protection, the highest quality of care and that they are properly protected. I welcome the fact that we are going to have a statutory home care scheme and all the additional home care supports that are being put in place. That has to be one of the approaches we take into the future as well.

This is not about public versus private nursing homes. Some of my family members were in private nursing homes for a long time and received great quality care. I am indebted to the people who provide, and work in, those services for the care they gave my grandparents over many years. I am sure others have had the same experience. Nursing homes, especially private nursing homes, were left in a very difficult situation during the very difficult time period of the pandemic. I will not rehearse what I have said already, but we know there were failings. Those failings must be acknowledged. If we are going to learn and change, we must first acknowledge those failings. The public inquiry I am seeking would not be a type of witch-hunt. It is not about apportioning blame. It is about establishing facts. When one establishes the facts one is in a position to learn and to deliver the changes that are necessary, which I do not doubt that the two Ministers of State who spoke are committed to in terms of their respective portfolios.

Before the pandemic arrived, there were issues relating to the need for adult safeguarding legislation. There is a commitment in the programme for Government in this regard. I accept that many legislative measures had to be put on hold as the State and the Department of Health dealt with the difficult situation of the pandemic, but we have to introduce these reforms as quickly as possible. If the Government introduces those reforms, it will have the support of Sinn Féin and the Opposition to do that as quickly as possible.

There was reference to adult social care teams. It is a fact that there is a two-tier system in the State. If somebody is a resident in a public nursing home, he or she has access to these safeguarding social care teams. If a person is one of the 80% in a private nursing home, he or she does not. There is an issue, as I have said for some time, and it has to be remedied if there is an individual instance of neglect and, in some cases, abuse. Obviously, if there are elements of abuse that are criminal in nature, the Garda of course can be involved. As we have seen previously, however, there are cases of neglect. We have seen it with Áras Attracta, Leas Cross and elsewhere. There are many instances of neglect which do not fall under the criminal code but which need to be investigated properly, yet it seems that no authority has the power of entry into a nursing home to do so. That has to change.

There is no excuse. The former Senator, Colette Kelleher, produced a Bill on adult safeguarding. We just have to do it. We must get it done and ensure that legislation is delivered. We must empower HIQA to issue compliance notices and give it more teeth to do what it needs to do. I agree with previous speakers about the TAPS funding. It cannot be money that is provided forever, but it was premature to cut that funding at a time when nursing homes are still obliged to put infection control measures in place.

I will finish by commending the Irish Association of Social Workers and Care Champions. Any review or inquiry that is carried out has to include the families of those who lost loved ones, survivors in nursing homes and the staff who did Trojan work during that time. My heart goes out to all those staff who worked in horrific circumstances. We must hear their voices. We need a public inquiry. Let us establish the truth and the facts, and then let us deliver the changes which are necessary.

Question put and agreed to.