Saincheisteanna Tráthúla - Topical Issue Debate

Home Care Packages

I have sought to discuss the crisis in staffing in the home care sector and Government proposals to address it. The reason I raise this matter is because I have been contacted by a number of constituents who are extremely anxious about the current difficulties with recruiting staff to care for people in their homes. In other words, home care workers. We know that we simply do not have enough home care workers and that hospital patients who are ready for discharge are occupying scarce hospital beds because of a shortage of home care workers. In September, the Committee of Public Accounts heard from the HSE's chief operations officer, Anne O'Connor, that there are not enough people applying for home care jobs in either the public or private sector. We hear that in some cases HSE community organisations are only able to deliver 60% of home care needed. This is impacting on patients who need home care in order to leave hospital, but it clearly is also impacting on many other people who require care in their own homes.

As we know, there is a policy, which I support, of decongregation or of moving on from congregated settings. As the Minister of State will be aware, that is the Government's policy. The concern is that the Government will simply not be able to move people on from congregated from settings or, indeed, to keep people from going into congregated settings without the recruitment of additional home care staff. There is a lack of any governmental response to this difficulty.

As I said earlier, I have been contacted by a number of individuals and organisations on this matter, including Home and Community Care Ireland, who told me that its providers is at close to full capacity. That organisation is on record that 8,000 carers are urgently needed in order to look after elderly persons in their own homes. I have called for a new a fair deal. We should be adjusting or amending the fair deal scheme to prioritise care for people in their own homes, rather than prioritising nursing home and congregated settings. This is a real concern.

I have also been contacted by people who are carers and individuals who require care, including one constituent who is upset in circumstances where a home care package has been compromised to the point where the person who requires care is expected to cover for home carers unpaid. I have also been contacted by a constituent who is a carer. She told me that as non-EU worker she does not have any security of status.

I am asking the Minister of State what the Government proposes to do about this? I understand that due to the exclusion of home caring from the critical skills occupational list prepared by the Department of Enterprise, Trade and Employment, many of those who are currently providing home care and who are from outside of the EU are leaving to work in nursing homes and hospitals. We need to ensure that there is an overall Government scheme put in place to ensure that we can recruit enough home care workers and that, if necessary, any issues around visas for those from outside of the EU who are carrying out home care are sorted out. The provision of employment permits is one issue. Staffing is an issue, but it is clear that conditions and pay in the sector are also issues. I have previously submitted a parliamentary question on this issue, to which I received a response on 9 November from the Tánaiste and Minister for Enterprise, Trade and Employment stating that a recent review of the critical skills exemption for the non-EEA employment permit system for home care workers did not recommend removal of the occupation of care worker or home carers from the ineligible occupations list. If we are not seeing a move towards resolving this issue at that level, I want to know what the Government is doing to ensure that we will have enough supply of home care workers to carry out the necessary care in the home that people like my constituent and his husband so badly require.

I thank Deputy Bacik for raising this very important matter. I know the issue of the home care sector is an important one for the Deputy.

The Minister of State, Deputy Butler, and the Government are committed to the development of improved community-based services, shifting care to the home and offering greater choice for older people. Last year, an additional €150 million was secured for home support to progress the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and to provide 5 million additional hours of home support. The HSE national service plan sets a target to provide 24 million hours of home support this year. It is estimated that at the end of September 15 million hours had been provided to more than 53,000 people. This is approximately 2.2 million more hours compared with the same period last year. The funding secured in budget 2021 to provide these additional 5 million hours has been maintained for 2022.

Significant inroads have been achieved in reducing waiting lists for funding approval for new or additional service, from over 7,800 in January 2020 to just under 400 in September 2021. This has been achieved through a combination of validation of the waiting list and availability of funding to address those waiting.

However, there can be delays between the approval of funding and the delivery of home support hours, and the numbers of people in this category have increased steadily this year. At the end of September 2021, there were 4,933 people assessed and waiting for a carer to become available. In January 2020, there were approximately 1,300 people in this category. Certain geographical areas that are experiencing increased pressures due to staff availability are particularly affected. Despite the increase, it is important to note that the total number of people waiting for home support across both categories has reduced from more than 9,000 at the start of 2020 to approximately 5,300 in September 2021.

The HSE is acutely aware that there are increasing capacity issues across both direct and indirect provision. It continues to advertise on an ongoing basis for healthcare assistants and to recruit as many suitable candidates as possible. It conducts its recruitment through a variety of channels, both at local level and through the shared service offices of the Health Business Services. Due to the nature of the role of healthcare support assistants, this recruitment is normally conducted at a very local level and is ongoing across the HSE. In addition, approved home support providers continue to recruit home support workers.

My colleague, the Minister of State, Deputy Butler, has committed to establishing a cross-departmental strategic workforce advisory group, the role of which will be to facilitate the views of stakeholders and examine workforce challenges in home support and nursing homes. Potential areas to be considered include recruitment, retention, training, career development and the sustainable employment of home care workers into the future.

Work is also ongoing within the Department to progress the development of the new statutory scheme to support people to live in their own homes within the broader context of the Sláintecare reforms. Recruitment of the 130 posts funded for the national roll-out of interRAI as the standard assessment tool for care needs is scheduled to commence in this quarter. A national home support office is in the process of being established. The testing of the reformed model of service delivery for home support commenced this month in one pilot site, with other pilot sites expected to be fully operational by January 2022. Overall, the testing will deliver up to 230,000 additional hours of home support in 2021 and 2022.

I thank the Minister of State for his response and for setting out the Government's aspirations, but it is shocking that nearly 5,000 people, according to his figures, have been assessed and are still waiting for a carer to become available. There is no indication, although he might be able to provide it, as to how long they have been waiting. The shortage of home care workers clearly indicates there is a recruitment crisis, which is causing immense hardship, distress and suffering to many of those who are awaiting the allocation of care hours and to the members of their family, who may be in their immediate household, who are currently taking on the role of carer. It is also causing immense uncertainty and hardship for carers. One individual told me she has sent emails to many Deputies, media outlets and others. She notes that the majority of clients are very vulnerable. People need care and there are people available to provide it but because of the difficulties with visas for non-EU workers, there is a recruitment crisis.

The response I received to a parliamentary question on this issue states that the difficulty is caused by contracts of employment and employment terms and conditions. These are the significant factors in the recruitment challenges faced by the sector, I am told, rather than a demonstrable labour market shortage. If that is the case, what is the Government doing to sort out the contracts of employment and the terms and conditions being offered? There is clearly an enormous need and demand for people to have access to home care assistants in their homes. It is extremely important for us all that we are moving towards a society where people are not required to be sent into congregated settings when they need care because the State is providing supports and care for such individuals in their own homes. I want to be of assistance in addressing this serious recruitment crisis. We need to see a freeing up of the logjam that is currently blocking access for people who need home care assistants.

Enabling people with care needs to continue living independently at home for as long as possible is a priority for the Government. That is why there have been significant inroads in some of the waiting lists. I acknowledge, however, that almost 5,000 people have been assessed and are waiting for home care hours to be delivered. It is a distressing situation for anybody to be in, but I assure the Deputy that the Minister of State, Deputy Butler, with the support of the Government, is making every effort to ensure those hours are delivered and to address the recruitment need. We want to get staff in place to address those needs. That is the only thing holding back the delivery of care. The assessments have been carried out and the funding is in place. The last piece in the jigsaw is dealing with the recruitment challenge. I again assure the Deputy that the Minister of State is making every effort in that respect.

Alongside the significant increase in the level of service provision, the demand for home support and its importance as an alternative service to long-stay care has grown considerably over the years. That demand is a positive development reflecting the fact that most people want to live independently in their home. There may have been an attitude in the past whereby people were put into nursing homes at a younger age. I am glad that does not happen to anything like the same extent as it did in the past. We need to support people to be able to live at home.

The number of home support hours in communities is increasing in line with enhanced investment. It is important to note that despite capacity challenges being experienced within home support services, it is estimated that the overall service delivery has increased by 17% based on the year-by-year activity levels. Efforts are ongoing to meet the continued increase in demand for the service. In addition, as I stated, the Minister of State has committed to establishing a cross-departmental strategic workforce advisory group to facilitate the views of stakeholders and examine the workforce challenges in supported nursing homes. The purpose of the group is to establish and assess why those challenges are presenting in terms of getting the additional staff in place.

Hospital Facilities

University Hospital Limerick, UHL, caters for the medical needs of the entire mid-west, including my constituency of Limerick City. The region also has St. John's, Ennis and Nenagh hospitals, as well as Croom Orthopaedic Hospital, but UHL is the large cog in the system. On Tuesday, 16 November, 95 people were on trolleys there, which was the highest number since the Irish Medical Organisation, IMO, started recording the figures. Fortunately, the number has reduced to 58 today. It is still a very high figure but it shows a good reduction.

The first point I want to make is that I am concerned about the coming winter period. The construction of a 96-bed acute block at UHL is currently out to tender. It is a project I have worked on for a number of years with the HSE and local UHL management. We want to ensure that once it goes out to tender, it will be funded and construction can get under way. However, I am more concerned about getting over the immediate winter period. Some 50% of ICU beds in UHL are now being taken up by Covid patients. There are currently 49 patients with Covid in the hospital, 13 of whom are in ICU. Those 13 people are taking up 13 of 28 ICU and high-dependency unit beds. This is a significant portion, which is way above the national average of approximately 40%. There are very few available ICU beds on any given day. Over the recent period, either one or no bed was free. We have seen six beds available, on average, over recent months and eight people in ICU.

The hospital's metrics in this regard are way above the national average. The number of patients with Covid is in the top three and it is consistently at the top of the list in terms of numbers on trolleys. The number of Covid patients is a major factor in the number of people on trolleys, which must be factored into the consideration of the issue.

Some €30 million is set aside under the winter plan. I want to ensure hospitals such as UHL can look for additional funding for staff such as junior doctors and I acknowledge the work done by the staff in UHL. They are under pressure all the time, with no respite, caring for the people of Limerick city and county, the entire mid-west and north Tipperary. I ask that the Government would, with the €30 million set aside under the €77 million winter preparation plan, look to assist UHL in getting over this winter period. It is very serious, when one looks at the metrics. We had 49 Covid patients in the hospital yesterday, 13 of whom were in ICU and nearly 50% of the 28 ICU beds are taken up by Covid patients. That is a consistent trend over the past month. The pressure must come off. We are now into the fourth wave of Covid, which will build up more pressure. I ask the Minister of State that the Government, the Department of Health and the HSE ensure UHL gets whatever help is necessary to get over this winter period in terms of dealing with the overcrowding in the emergency department, ED, in UHL.

I thank Deputy O'Donnell for raising this very important issue around University Hospital Limerick. The Deputy has been passionate on this issue for a long time and raises this matter on a consistent basis, both behind the scenes and in the Dáil Chamber.

I acknowledge the scale of the challenge facing our emergency departments as we head into what is expected to be a very difficult winter. I thank our emergency department staff for their ongoing commitment to delivering a high standard of care to ED patients, while acknowledging the distress that overcrowding causes to patients and their families and to front-line staff. There were 6,996 attendances at the emergency department in Limerick in October 2021, up 24% compared to October 2020 and 16.4% compared to October 2019, although, in the year up to 18 November 2021, trolley counts for UHL remain 35% lower than 2019 levels.

The UL Hospitals Group has reported it is continuing to deal with record volumes of patients attending the UHL emergency department, a pattern that has been sustained over a number of months and is being replicated throughout the country. The hospital is continuing to follow its escalation plan, which includes additional rounds, accelerating discharges and identifying patients for transfer to model 2 hospitals. Surge capacity is open in UHL and in Ennis and Nenagh hospitals to meet the current demand and scheduled care remains under review.

There has been and continues to be substantial investment in UHL and the wider hospital group in recent years, to address capacity issues, including a new emergency department that opened in 2017. In the past year, 132 additional beds have been provided. These include the new 60-bed modular ward block at UHL, a 24-bed single room rapid-build ward and the reconfigured 14-bed high-dependency unit, HDU.

The winter plan 2021-22 was published on 15 November. We are investing €77 million in this year's winter plan, in addition to the 2021 funding, which has been retained. The plan recognises that a whole system response is required and outlines how the HSE proposes to manage winter challenges across primary, community and acute care, including measures to allow the public system to access private healthcare capacity. The plan will provide for the appropriate, safe and timely care of patients by ensuring, insofar as possible, effective levels of capacity and resources are in place to meet the expected growth in activity levels.

I acknowledge the 98 additional beds that have gone into UHL. Some 60 modular beds, for which I campaigned over a long period of time, are in place. However, that 60-bed ward is being used as a Covid unit. It is not being used for that which it was really intended, which was to relieve the existing pressures in UHL. We have 49 patients in UHL with Covid. That is in the top three in the country. We are the top hospital in Ireland in terms of trolley waiting lists.

I believe in trying to manage a situation, rather than being reactive at the end, when it gets very difficult to deal with. When these major warning signs are appearing and 95 people were on trolleys two days ago which is, thankfully, down to 58 today, now is the time to allow UHL apply for funding under the €30 million put aside under the winter plan for acute hospitals, to alleviate the pressures on the recruitment of staff. I acknowledge, once again, the phenomenal work of the nursing and medical staff and management and everyone working there and trying to deal with a very difficult situation.

However, the facts speak for themselves. We have a crisis in terms of the number of patients presenting with Covid in UHL. That needs to be acknowledged by the HSE, Government and the Department of Health. Commitment from Government is now required in order that UHL can look to get these additional resources to get over the winter period, such as the recruitment of staff including junior doctors and other areas, to ensure we can get over these critical winter months and to get the tender through on the 96-bed block and get the building under way. However, a major crisis is presenting that we have to get through in the next number of months and that is under the winter plan. Can we get a commitment from Government that UHL can make that application and that it will work with UHL to deal with this major problem of overcrowding and Covid patients?

I thank Deputy O'Donnell again for raising the important matter around University Hospital Limerick and capacity. The health service capacity review 2018 was clear on the need for a major investment in additional capacity in both acute hospitals and community, combined with a wide-scale reform of the manner and location of where our health services are provided. In January 2020, 795 additional beds have been provided on a permanent basis, over the number available at the end of 2019.

The programme for Government, Our Shared Future, commits to continuing investment in our healthcare services, in line with the recommendations of the health service capacity review and the commitments in Project Ireland 2040. It is accepted a key part of the solution for Limerick is additional beds. The new 60-bed modular ward block at the university hospital is a significant step, but I heard the Deputy's comments on its current use. This ward provides modern, single-room, in-patient accommodation and improved infection prevention and control capabilities, as well as patient flow throughout the hospital. This follows the completion last year of two separate rapid-build projects delivered under the Government's national action plan in response to Covid-19, which provided an additional 38 inpatient beds on-site at UHL.

Furthermore, Project Ireland 2040 includes the provision for a 96-bed replacement ward block at UHL. The project is currently out to tender with tenders due to be returned in late January 2022. The tenders received will then be evaluated and it is anticipated the works contract will be awarded in early quarter 2 of 2022, subject to HSE board approval and funding availability. The Department and the HSE will continue to work with local hospital management to further improve patients' experience in UHL. I will bring Deputy O'Donnell's further comments to the attention of the relevant Ministers.

Housing Provision

I was reading back on interesting articles to do with the State's investment in property and housing. It is clear the State is one of the biggest players in the property market, but one would not think so, because State agencies and local authorities are renting and leasing properties back from the State. If one looks at the total investment by the State into the Ireland Strategic Investment Fund, which is basically to vulture and cuckoo funds, it adds up to €1.63 billion in the recent past. I say that to set the backdrop of the attempts by the community of St. Michael's estate in Inchicore to advance the development of 9.2 acres of prime land in the middle of Inchicore for the sake of that community.

For 21 years, the community around St. Michael's estate has been fighting to regenerate in a sustainable way. Thankfully, Thornton Heights was built, but there is a big chunk of land lying empty. There is now a designer talking to people on the regeneration board. We do not know what costs the designer is working with.

We need to find out here today where the regeneration of St. Michael's estate is at. Will a certain cost be made known to the designer, so that we can have good quality, affordable housing on that land? We do not just need good quality, affordable housing. The affordable rent should not be set at a share of the market or 25% below the market value. Rather, the affordable rent should be a proportion of the income of people who will live in those dwellings. This is an important point for the regeneration of St. Michael's estate. It should be publicly owned and funded in a way that the cost rental element will mean a proportion of the tenant’s income is paid on rent rather than set at 25% less than the market value. That figure is meaningless, because that market value is in a never-ending onwards and upwards scale. This would defeat the whole point of the struggle that community has engaged in for the past 21 years.

My colleague Deputy Smith and I are here to represent and raise the concerns of the St. Michael's estate community. They have been waiting and waiting for the regeneration. As Deputy Smith said, they have been fighting for 21 years for the regeneration of St. Michael's estate. They need clarity. They need certainty that the regeneration will provide housing that is affordable for that community, that they will be able to access it, and that they will not be priced out of it. There is a huge concern that the cost rental segment will be set at a price linked to market rate rents. Market rents are crazy at this moment. They are wildly fluctuating and will do so into the future. Housing for All says cost rental is to deliver at least 25% below market rents. The community needs certainty that the rents will not be based on the market rent. They need certainty that the rents will be affordable and that they will be based on what is actually cost rental and not connected to market rents. We need that clarity for the community. The community needs clarity that whatever is built there will be accessible to the community.

I thank Deputies Smith and Costello for raising this important matter around St. Michael's estate and on how the rent will be set. I am aware the Minister of State, Deputy English, responded to a similar query from Deputy Joan Collins on Tuesday, 16 November on this important cost rental development at Emmet Road. As indicated by the Minister of State, I can confirm that any rent levels for the cost rental homes to be delivered in the Emmet Road development will not be directly related to, or set based on, tenant income or the market rent for the area.

A central principle of cost rental is that the rent for the homes is a function of the costs incurred in financing, building, managing and maintaining them. There is now a clearly established legislative basis to operationalise this principle and for establishing the rent in a cost rental development. This can be found in Part 3 of the Affordable Housing Act 2021. These provisions were approved by the Oireachtas in July of this year by 101 votes to eight.

I would like to be clear that although cost rental will be public housing, it is not social housing. It does not use a differential rent structure. It is targeted at those individuals and families on moderate incomes and above the eligibility threshold for social housing who can afford to pay the cost rents. To illustrate this in practice, in terms of tenant eligibility, an upper limit of €53,000 annual household income, after income taxes, has been applied to the first cost rental projects. There is no lower threshold, though tenants would obviously be required to be in a position to pay the cost rent from their income. To reiterate, the rents for cost rental properties are not set by market rents but are in line with the criteria outlined in the Affordable Housing Act. Any references to market rent for cost rental homes simply serve as relative comparisons. They demonstrate how much more affordable these properties are for the eventual tenants when compared with what is available on the private rental market. Consideration of market rents can also help target State funding supports for proposed cost rental schemes at areas where they will offer the most assistance to tenants who would otherwise be facing comparably high rents.

The Government's cost rental scheme is already delivering long-term homes to families at affordable and stable rents. Using upfront capital subvention from the new cost rental equity loan, CREL, scheme, approved housing bodies, AHBs, are charging cost-covering rents at Taylor Hill in Balbriggan of €935 per month for two-bedroom homes, and up to €1,150 per month for four-bedroom homes. A further 50 homes at Enniskerry Road in Dún Laoghaire-Rathdown will be tenanted next month for €1,200 a month for modern two-bedroom apartments, with more to follow, including at Barnhall in Leixlip, County Kildare. These rents are affordable for the target cohort above the social housing income limits.

It is anticipated that similar capital subventions will be utilised at Emmet Road to make the resulting cost rents as affordable as possible, including the provision of public land at no or low cost, upfront capital grants from the Exchequer and State assistance with loan financing through the Housing Finance Agency and the European Investment Bank.

The Minister of State said the provision of public land would be of no cost. I would assume it would be of no cost because it is public land. It should not add to the cost of building homes on it. I want to go to the Minister of State’s figures. There is a maximum threshold of €53,000 to qualify for affordable housing. A combined income of €53,000 in a home where two people work would mean they would both have to be on just above the minimum wage to meet that threshold of €53,000. This makes a joke of what is being attempted.

I remember in 2008 when Bernard McNamara, the previous public private partnership developer who was to develop St. Michael's estate pulled out of the scheme. The people protested at City Hall saying, “greed, greed, how much do you need, Mr. McNamara?” Here, we have to be very careful. When we look at what is affordable for ordinary people on low incomes, we have to take into account their lives, their ability to pay and the sort of communities they want to live in, not the profit margins of the developers. This is why I quoted those figures at the beginning. The State has a fundamental role in financing such developments so that people can live quality and rooted lives in their communities.

The disconnection from market rents is a positive aspect. It is the sort of thing that needs to happen. Yet, we need to factor in the tenant’s ability to pay. Otherwise, we are still creating properties that will be unaffordable for a huge number of people. The reality is that the threshold at which social housing becomes unavailable to people is far too low. It has not been reviewed in a long time. The threshold needs to be raised. As that is raised, the upper threshold for cost rental also needs to be increased.

I welcome the Minister of State's statement about subventions by the State to keep the costs low. Ultimately, the rents will only be made affordable if we keep the costs low. Loans from the Housing Finance Agency and the European Investment Bank need to be of a sufficiently long term to reduce the cost and to keep these rents affordable.

The four local Members and the community will not stop fighting. The community has been fighting for 21 years. They will not stop. We will keep pushing to ensure these rents are affordable. However, as I say, we need to look at the threshold for social housing and for cost rental and increase them, because they are far too low as they stand.

I thank Deputies Bríd Smith and Costello for raising this important matter around St. Michael's estate and how the rents will be set. Within the past year, the Minister for Housing, Local Government and Heritage has developed an entirely new policy framework to enable the development of cost rental housing in Ireland, culminating in its inclusion in the Government’s Affordable Housing Act. The Minister has also rolled out funding for cost rental through the cost rental equity loan schemes for approved housing bodies, AHBs, and the affordable housing fund for local authorities.

The Government's Housing for All plan included a number of significant improvements to the affordable housing fund for local authorities above and beyond the previous serviced sites fund, under which Dublin City Council had been approved for €18.7 million in funding. These changes include allowing the funding support to exceed the previous maximum €50,000 per affordable dwelling on a step scale up to €100,000, based on location and density. This could assist a reduction in rents at this important site even further. When this capital subvention is combined with utilisation of local authority land and the long-term low-interest finance available from the Housing Finance Agency and the European Investment Bank, the level of financial supports will have a real impact on the resulting rents that can be charged for these types of homes. These will not be linked to the market or tenant income and will be financially sustainable cost rents, as set out in the Affordable Housing Act.

The Department of Housing, Local Government and Heritage fully supports the cost-rental development and will continue to work with Dublin City Council to achieve its realisation.

Residential Institutions

I am raising this issue on behalf of the survivors of mother and baby homes and county institutions across the country, who are outraged, deeply upset and insulted at the provisions made in the redress scheme that the Minister has published. To be frank, the redress scheme announced this week is an exercise in exclusion rather than compassion. I have been contacted by a number of survivors of Sean Ross Abbey who are more than just furious at the exclusion of infants who spent less than six months in a mother and baby home from accessing redress or an enhanced medical card. They are deeply upset and feel let down yet again. These emotions are being felt right across the country. Every time this Government claims to act compassionately towards the survivors of mother and baby homes it creates controversy, giving survivors more battles they have to fight and compounding the sense of exclusion they have felt for decades. For the life of me I cannot understand why people who, as infants, spent less than six months in mother and baby homes are excluded from accessing redress or an enhanced medical card. This six-month rule is completely arbitrary. I ask the Minister to outline to the survivors how that time period was decided upon and what factors were taken into account that resulted in the conclusion that the six-month exclusion point was appropriate. I would appreciate an answer to that.

Every minute spent in these hellholes was a minute too long. It only took the religious orders a moment to make the decision that would fundamentally affect the entire future of a young child and his or her mother by systematically and forcibly separating them. These children were betrayed from the start of their lives and they have been betrayed again this week. The Minister has said that infants who spent less than six months at one of these institutions would not have recollections of their time there. However, they live with this every day of their lives. To make it worse, they have had to spend much of their lives fighting for their right to be excluded no more. They are well aware of their time in these institutions.

There is no recognition in the redress scheme of the hurt or trauma experienced by children separated at birth from their mothers. That is an unfortunate fact. I was speaking to one such person this week, Teresa Collins. The Minister has spoken to her himself. She is a survivor of Sean Ross Abbey and is excluded from his scheme. This week, she feels abandoned by the State and like she is not being treated like a human being. That is how she described the attitude conveyed through the redress scheme. What does the Minister have to say to her and to the many others in similar situations?

I also ask him to justify his comment that as the commission did not focus on the boarded out phenomenon, as he put it, he was not in a position to compensate those people. Many of these children suffered horribly after being boarded out under the eye of the State. Just because the commission did not focus on it does not mean their experiences do not count. I also refer to the sliding scale of payments. This needs to be reviewed urgently as it creates a hierarchy of suffering, as do the six-month rule, the exclusion of boarded out children and the fact that this scheme is based on a commission report that has been widely rejected by survivors. This scheme is similar to the commission of investigation in that it is unfit to assist the people it impacts. The commission did little but give rise to a scandal and this scheme has a similar future.

I thank the Minister for being here to deal with this matter.

Following intense deliberations over the past months, on Tuesday the Government approved an action plan for mother and baby institution survivors and a mother and baby institutions payment scheme. This payments scheme goes significantly beyond both the recommendations of the commission of investigation and those of the interdepartmental group that was established to bring proposals to me. It will provide supports with a value of more than €800 million. It also stands as part of a much broader Government response that seeks to address the priority needs of survivors and former residents.

I have met with many survivors over the past 12 months. Through these meetings, and through the results of the consultation that was undertaken in developing the proposals for the scheme, it is clear that redress comes in many forms for people. While approximately 34,000 survivors will benefit from a payment under this scheme and 19,000 will receive an enhanced medical card, this is just one element of the Government's comprehensive response to the commission’s final report. The diverse needs of those who spent time in a mother and baby or county institution will be addressed across the Government's action plan.

The payments scheme will provide a general payment for time spent in the institutions, recognising the harsh conditions, the trauma and the other forms of mistreatment experienced while resident there. It is designed so that people who spent the longest time in these institutions as mothers or young children, and endured the harshest conditions, will receive the highest level of award. For people who were adopted or otherwise separated from their birth family, the overwhelming priority need that has been expressed to me is access to records. For those children who spent short periods in an institution during their infancy, the Government’s action plan provides a response to their needs in the birth information and tracing Bill. This legislation will provide guaranteed access to an unredacted birth certificate, as well as wider birth and early life information for those who have questions about their origins. I want to advance that legislation as quickly as possible. For children who spent six months or more in an institution, the Government response further acknowledges the harsh institutional conditions endured by those children. In doing so, it has moved beyond the distinction made by the commission between children who were accompanied and those who were unaccompanied.

With regard to the situation of mothers who spent less than six months in an institution, the Government felt that the pain and trauma that they experienced as a result of being admitted to a mother and baby or county institution should be acknowledged by a financial payment. While I acknowledge that it is not and never will be possible to place a monetary amount on any person's trauma, a financial payment was felt to be an appropriate response in these cases. The graduated payment rates under the scheme will proportionately acknowledge the more prolonged experience of harsh institutional conditions, which were endured by all those who spent longer periods in excess of six months in these institutions.

These decisions were taken with a focus on both the core need of the survivor and the appropriate available response. This was not, and has never been, done with any intention to exclude. Time and again it was made clear to me by survivors that they wanted a scheme that was non-adversarial and easy to access and that would not re-traumatise them. It was concluded that the best way of doing this was through an approach that does not require applicants to bring forward evidence of abuse or harm and does not require them to be cross-examined, thereby risking further re-traumatisation. A scheme based on the level of time spent in an institution, which can be accessed by simple proof of residence across that time, delivers on this key objective.

The Minister and I, and other Members, have met survivors. I assure him that whether they were there for one day, five months and 29 days or six months and two days, all these people were affected exactly the same by being separated from their families and decades of trying to get answers from the governments. This sliding scale effectively tells them that their forced separation and suffering is not worth any compensation.

I mentioned Teresa Collins. This is not about money for her, or for many of the other survivors to whom we all speak; it is about recognition. This redress scheme does not recognise the vast majority of people who have been caught up in this. That is where the problem is for Teresa Collins and those who were in Sean Ross Abbey and other places. The Minister is failing here and he needs to revisit this awful scheme. It is as simple as that. This issue has increased my concerns about what the future holds when it comes to the demands that have been made for scans in Sean Ross Abbey. Is it another case of the Government dragging people along for another while and letting them down again? That is what has happened here with the redress scheme. People have been dragged along, have not been listened to and there is no recognition for them. Suddenly, there is a bombshell that a big cohort of people who were caught up in these institutions are being excluded. As I said, it does not matter whether they were there for one day, five months and 29 days, or six months. It happened. It is time the Government, no matter who is in it, recognised that and gave these people the redress they deserve.

It is disappointing to hear that the Minister recently wrote to the religious orders requesting that they contribute to this scheme. There should not be a question in that regard. This might require legislation but they are responsible, as well as the State, for what these families and children have suffered. It is time to get the finger out. I have always had faith in the Minister and I thought we were moving forward but during the week I started to have my doubts again I think he can do the right thing. It is time he got in touch with these religious institutions and forced them to pay well into this redress scheme.

I absolutely agree with the Deputy that every person who spent any amount of time in these institutions was impacted, although I am not sure I agree that every person was impacted the exact same.

Certainly my engagements with survivors would suggest that people have different responses and reactions to the time spent in the institutions but I agree with Deputy Browne that everyone was impacted. It is the desire and intention of the Government, across the action plan and the 22 actions, to respond as best we can to the needs and desires of each and every individual survivor while also recognising that the needs and priorities of survivors are different across the approximately 58,000 survivors, both mothers and children, who we estimate are still alive today.

In respect of people who were boarded out, I want to make it clear that anybody who spent more than six months in a mother and baby institution and was subsequently boarded out will receive a financial payment and a medical card for the period of time he or she was in the mother and baby home. I want to make that very clear because I know there are thousands of such survivors who were in a mother and baby home for more than six months; often they were in such homes until they were four or five and then they were boarded out. The commission did not examine the process of boarding out in the level of detail that allows us to make broad awards in the way we are making them for those who lived in mother and baby homes. The commission did a detailed piece of work in examining the conditions across the mother and baby homes and county institutions.

In respect of the religious orders, I absolutely agree with the Deputy that it is right that they would make a substantial contribution. I will be meeting them in the next number of weeks to start the process of achieving that. I believed it was important that I get this scheme launched and that I advance both the birth information and tracing Bill and the institutional burials Bill. They were my priorities. I was never designing this scheme solely on the basis of the response of the religious institutions but it is essential, if their apology to survivors is to mean anything, that they contribute substantially. I will speak to Deputy Browne privately about the engagement we had previously on Sean Ross Abbey and those scans.