Select Committee on Health debate -
Wednesday, 12 Jun 2024

Health (Miscellaneous Provisions) (No. 2) Bill 2024: Committee Stage

An Leas-Chathaoirleach

The purpose of today’s meeting is to consider Committee Stage of the Health (Miscellaneous Provisions) (No. 2) Bill 2024. The primary aim of the Bill is to provide amendments to the Health Act 2007 and the Nursing Homes Support Scheme Act 2009. Amendments to the Health Act 2007 will strengthen the regulatory framework for residential care centres. Amendments to the Nursing Homes Support Scheme Act 2009 will widen the definition of those who are considered to be a “family successor” to a family farm or a productive business asset under the nursing homes support scheme, which is now more generally known as the fair deal scheme.

I welcome the Minister of State at the Department of Health, Deputy Butler, to our meeting this morning. She and her officials are very welcome. Does she propose to make an opening statement?

Minister of State at the Department of Health (Deputy Mary Butler)

I do, and I will keep it short. I thank the members for attending and for their support for this Bill. This legislation, when enacted, will achieve a number of aims. Through amendments to the Health Act 2007, it will strengthen the regulatory framework for residential care services for older persons, people with disabilities and children in need of care and protection. The first amendment to the Health Act 2007 is the introduction of compliance notices to provide a more timely and proportionate tool for intervention by the chief inspector when there is a breach of regulations.

Focused on bringing the provider into compliance, it complements the existing enforcement processes under the Act. The second amendment provides a clear legal basis for the chief inspector to enter and inspect a premises that is not registered if there are reasonable grounds to believe that the business of a designated centre is being carried out. The purpose of this amendment is to provide explicitly that those who are residing in unregistered centres will get the same protections as those who are in registered centres.

The third amendment will reduce the timeframe that service providers have to make representations or appeal a decision of the chief inspector for current enforcement processes under section 51 of the Act from 28 to 14 days. This amendment will make these processes quicker so that the chief inspector can take timely action to safeguard residents. The Bill also introduces a new provision in relation to the periodic and systematic collection of key data from nursing homes, the sharing of the data with the Minister, the Health Information and Quality Authority, HIQA, and the HSE, where appropriate, and the publication of this data at aggregate level. It is important to emphasise at this point that data will not be collected at an individual level and if there is a risk of identifying an individual, the data will not be shared or published.

Finally, through amendments to the Nursing Homes Support Scheme Act 2009, this legislation will expand the definition of those eligible to be considered as a "family successor" to a family farm or productive business assets under the nursing homes support scheme to include first cousins, great-nieces and nephews and great-grandchildren. This is important for those who do not have immediate family and will further protect the viability and sustainability of family farms and businesses. There are also a number of technical amendments to the Nursing Homes Support Scheme Act as set out in the Bill.

At this stage, I wish to inform the committee that I am in the process of finalising two amendments to this Bill that I intend to introduce on Report Stage. The first relates to the Nursing Homes Support Scheme Act. Having taken on board the comments raised by Deputy Cahill in the course of the Second Stage debate on this Bill, I am in the process of finalising a further amendment to clarify the eligibility for “family successor”. This will take the form of a further amendment of the Nursing Homes Support Scheme Act 2009 to broaden the definition of “first cousin” to include more blood relatives in the grandparental lineage. This is to facilitate the inclusion of younger second- and third-generation relatives in the successor scheme, while still remaining under the first cousin parameters. The rationale to explore widening the base of “cousin” is with regards to older farmers or business owners, whose choice of family successor may be limited to a first cousin who is of a similar age to themselves and as such is not in a position to take on the responsibilities associated with running the family asset. This will further protect the viability and sustainability of family farms and businesses that will be passed down to the next generation of the family.

The second amendment I am proposing to introduce on Report Stage is a minor amendment to section 48 of the Mental Health Act 2001. As Deputies will be aware, the drafting of a mental health Bill is at an advanced stage, with the intention of it being published during this session. However, there is one pressing amendment I would like to now bring forward for practical reasons. This amendment will change the length of time a person can serve on a mental health tribunal operated by the Mental Health Commission from the current term of three years to five years. The Mental Health Commission will begin the recruitment process for tribunal members very soon and including this amendment in this Bill, rather than the forthcoming mental health Bill, will allow the commission to plan now for the appointment of tribunal members for five years. As each tribunal member recruitment campaign costs the Exchequer in the region of €250,000, this amendment will have an immediate positive impact on the public purse.

An Leas-Chathaoirleach

Before moving on, I want remind members of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I also remind members that they are only allowed to participate in this meeting if they are physically located in the Leinster House complex. In this regard, I ask that all members, prior to making their contributions to the meeting, confirm they are on the grounds of Leinster House. I also remind members that should a division be called, they must physically come to the committee room in order to vote.

Apologies have been received from the Chairman of the committee, who cannot be here this morning. No amendments have been tabled so I presume it will be quick. The Minister of State has indicated that she will bring in two-----

Deputy Mary Butler

Two amendments on Report Stage, with the co-operation of the members.

An Leas-Chathaoirleach

Deputy Shortall has indicated that she wishes to say something.

Deputy Róisín Shortall

Can members make comments now, because we will probably race through the sections?

An Leas-Chathaoirleach

Yes, that is okay. Do Deputies Shortall and Daly wish to make a comment on this?

Deputy Róisín Shortall

Yes.

An Leas-Chathaoirleach

We will allow that.

Deputy Pa Daly

I have a comment on section 13. I can speak about it when we get to it. As the Minister of State can see, I am substituting for Deputy Cullinane. It gives the right of entry to the unregistered centres and it empowers a chief inspector with a right of entry for registered centres.

I have a query for the Minister of State. Has she considered expanding the legal right of entry to social workers or safeguarding teams to ensure that they have a right of entry? Has she considered legislating for a care partner scheme similar to the one in the Six Counties? That was successful, particularly during the pandemic, in supporting people who were isolated. That scheme prevented isolation and neglect. We are considering a potential Report Stage amendment to give the Minister the power to enable this for social workers. We will support any enabling powers for the Minister to implement such a scheme, as well as for a right of entry for social workers and safeguarding teams. We are also considering a Report Stage amendment to insert a requirement for a review of the operation of the Act to ensure that the powers under the principal Act and this Bill are operating to the expected and intended standard.

Deputy Mary Butler

Will I respond now or should I wait until we reach section 13?

An Leas-Chathaoirleach

I want to take all the comments together first. I call Deputy Shortall.

Deputy Róisín Shortall

I welcome this Bill, in so far as it goes but it is very limited. The Minister of State knows very well that so much more needs to be done regarding nursing homes. I find it hard to understand why she is only dealing with this very limited number of improvements to the inspection and oversight regime. For a start, she promised that a statutory right to home care would be introduced. That promise has been made since 2018. She has repeated it several times but there is no sign of it. When is it actually going to happen? It is an equally important to introduce that statutory right because what is happening at the moment, given the statutory right to the fair deal scheme, is that people are being funnelled into nursing homes who actually should not and do not want to be there. They would be much better off and would much prefer to be in their own homes with home care.

The Minister of State has actually come down very much in favour of a very privatised, commercial model of care for older people and that is a real problem. We saw the effect of that during Covid. At that time the Taoiseach and the then Minister for Health both promised a complete review of the big, large-scale, single-room nursing homes that are not conducive to well-being for older people but the Government has done nothing about promoting a more domestic model of care, either in small nursing homes or, preferably, for people to stay in their own homes. That has been really remiss of the Minister of State during her term of office. We are four and a half years in and essentially, we are no closer to having a statutory right to home care and we are continuing to funnel older people into circumstances that are far from ideal for them. I do not know why the Minister of State is doing this. She is promoting very large-scale nursing homes, with up to 200 beds, which are an entirely inappropriate setting for older people. She is not providing them with the choice they should have and that is very remiss of her. I have given her the benefit of the doubt throughout her term of office but she has not acted on this. In terms of a Minister of State with responsibility for older people, it would be a primary responsibility to deal with the issue of the optimum model of care for older people. We will pursue that issue at this committee but it is really regrettable that older people are given very little choice.

I also have concerns about some aspects of this in terms of the preferential treatment being given to members of the farming community, which is entirely different from the approach that the Minister of State has taken to inheritance for urban or non-farming families. There is big pressure on in here and strong lobbying by the farming community and the Minister of State is creating an imbalance.

The other issue relates to the mental health aspects of this and the mental health tribunals. While this is not core to the Bill, she could take the opportunity, as is her prerogative, to introduce a much-needed amendment to give the Mental Health Commission responsibility for the oversight of CAMHS. Yesterday I attended another meeting hosted by Families for Reform of CAMHS who laid out a litany of disgraceful treatment of children with mental health issues. Their primary, single call was for the Mental Health Commission to be given responsibility for the regulation of CAMHS. The Minister of State could have done that in this Bill.

Deputy Mary Butler

No, I could not.

Deputy Róisín Shortall

I intend to table an amendment on Report Stage. The Minister of State has opened the door on non-core aspects of this Bill given what she said earlier and I hope she might take time to consider that. She has given various promises about the Mental Health Commission taking on that responsibility. It is desperately needed, given the appalling state of children's mental health services. I will raise that on Report Stage.

Deputy Mary Butler

I thank the Deputies for their comments. I acknowledge Deputy Daly is filling in for Deputy Cullinane. The right of entry for social workers under the safeguarding policy will be legislated for. The recruitment phase is at a very advanced stage to put in place a chief social worker in respect of the safeguarding piece we are bringing forward.

The Deputy also asked about a care partner scheme. The scheme in Northern Ireland was introduced during Covid on an administrative basis but is no longer in place. We want to strengthen the right to visiting, even in outbreak situations and this is part of the proposals being considered for revised regulations. We are engaging with stakeholders on this and hope to amend the regulations very soon. That is where we are on that. Of course, whatever amendments Deputies table will be examined.

Deputy Shortall raised quite a number of issues. First, I want to completely rebut her suggestion of preferential treatment for farmers. When the legislation was introduced in 2009, all those with a principal private residence, apart from farmers and business owners, were excluded from the 7.5% charge on the value of their house, land or properties after three years. The charge applied to those with a principal private residence but after three years in a nursing home, that stopped and people no longer had to pay the 7.5% charge. There was an anomaly there in that farmers and business owners continued to pay the 7.5% charge even after being in a nursing home for three years. The purpose of the Bill I introduced almost three years ago was to address the situation whereby farmers, specifically, were afraid to go into nursing homes because the value of their family farm could have been wiped out in instances where they stayed longer in a nursing home. Now we see that the normal length of stay in a nursing home is between 12 and 14 months. I have to rebut completely the Deputy's suggestion that there is preferential treatment of farmers; they were actually not treated properly when the Bill was introduced in 2009. Now the situation is that after three years everybody, regardless of what land or businesses they have, will no longer have to pay the 7.5% charge. It expires after three years for everybody in a nursing home.

With regard to the statutory home care scheme, on the day I introduced this Bill in the Dáil, which is three or four weeks ago now, the Cabinet gave approval for the legislative piece, which is being worked on at the moment. I hope to introduce that very quickly. It relates to standards for those who provide home care, whether they are public, private or voluntary. That is a piece that has to be done before we can legislate for statutory home care.

Deputy Róisín Shortall

When is the other legislation on the statutory right due?

An Leas-Chathaoirleach

We are dealing with statements only. We cannot have interruptions.

Deputy Mary Butler

That legislation is currently being worked on. We cannot have statutory home care until we have the legislative piece in place.

The other issue raised was that of an amendment relating to the mental health Bill. That legislation is very close to publication.

My expectation is that it will go to Cabinet on 2 July and be published that week. I want to introduce it on Second Stage in the week commencing 9 July. The minute the recess is over, after Second Stage we will be able to work it through the Dáil and Seanad. It is a lengthy Bill, comprising 180 heads and over 500 sections. It is the second most complicated piece of legislation that will ever be brought before the Dáil. The most important thing is that we get it right. We are just there.

I meet the Attorney General on a weekly basis to ensure the timelines do not slip any further. It is not that the timelines are slipping; rather, it is such a complicated Bill and is very legal and technical. Every time a clarification is needed, it has to go to the Office of the Parliamentary Counsel's legal teams. That all takes time. The reason the Mental Health Commission was anxious for us to move this amendment was that the Bill will be more or less determined from September onwards. The commission wants to start recruitment immediately in regard to tribunals. It is a costly process. It wanted to make sure it could work ahead in relation to that.

Deputy Róisín Shortall

Does the proposed mental health Bill provide for the Mental Health Commission to regulate CAMHS?

Deputy Mary Butler

Yes.

Deputy Pa Daly

I will respond to what the Minister of State said. There was a proposal for a pilot scheme on mental health in Limerick, where a mental health nurse would be in an ambulance going to people who had mental health episodes, due to the thousands of call-outs gardaí have to make every year. Twelve months on from when the pilot scheme was supposed to have been introduced, there is still no sign of it. There is massive demand around Munster for such a scheme. People who have an incident in Kerry, for example, are waiting on a private team to come from Cork. It is impossible for there to be immediate access. Are there any proposals in that regard?

Arising from the question on CAMHS, the redress scheme for south Kerry CAMHS is limited to a certain period of time. There are also people whose treatment commenced before 2016. North Kerry CAMHS patients have received apologies from the HSE for the deficiencies of care in their treatment. However, those in the redress scheme will receive €15,000 for special damages and paying for reports to cover some expenses. Even though other people have received apologies, they are excluded from that scheme. They are being further punished. It is more difficult for them to progress their legal cases. The average report costs about €3,500. The assistance south Kerry patients in the scheme are receiving is of great benefit, but others do not get it. Where the HSE has held up its hands and said there have been deficiencies in care, why not give those affected money to help them progress their cases? It seems unfair that they are not included when an apology has already been given.

Deputy Mary Butler

On the Deputy's question on a pilot scheme in Limerick operated by the Department of Justice, the Garda and the Department of Health, with mental health services leading that, the proposal was that it would be trial. It is a diversion tactic to prevent people with mental health difficulties, especially those who have committed a low-impact crime, from entering the system.

Last year, there was a large conference where we heard from people who deliver police services in Canada, Northern Ireland and America. The proposal is that a person, not necessarily a consultant psychiatrist but someone who is qualified in respect of mental health, would travel with gardaí to specific incidents. We now have five crisis resolution teams in place. They work out-of-hours from Thursday to Sunday, starting at 3 p.m. The areas covered include Cork, Waterford, Galway, Sligo and Dublin.

The scheme will be expanded. It is important because a lot of issues arise out of hours. We are working closely with our colleagues in the Department of Justice to get this pilot up and running. There are a lot of complications attached to it and we need to have the right personnel to travel with gardaí. Gardaí would have to analyse each case in advance to make sure they are not putting somebody at risk. I can get the Deputy a note on that.

Deputy Pa Daly

Does the Minister of State have any idea when the pilot is likely to start?

Deputy Mary Butler

We will get the Deputy a note on that.

On Kerry CAMHS, I do not have the note in front of me but the families of approximately 200 of the 240 children who had harm caused to them have entered the redress scheme. They are going through the system. It is non-adversarial. I can get the Deputy a note on the exact number. He has spoken specifically to north Kerry.

Deputy Pa Daly

North Kerry, or south Kerry where the treatments commenced before 2016. It is quite limited.

Deputy Mary Butler

We are currently doing a full look-back in north Kerry. That was a commitment I gave in cases where any of the audits threw up a situation where red flags were raised, and they were raised in north Kerry. As the Deputy knows, Dr. Maskey was not available and was not in a position to carry out a review after doing the first one. We found it hard to get somebody to do the full look-back, but that work is under way.

I have said categorically that some young people have fallen outside the terms of reference of the compensation scheme. When the review is concluded, that will be looked at. We cannot look at it until we have the results from the north Kerry audit, which are due very soon.

Deputy Pa Daly

If there has been an admission of liability, can the families not be given the money to help them progress their case?

Deputy Mary Butler

My understanding is that anyone who enters the scheme in good faith and signs the terms and conditions has received €5,000 initially, and subsequently up to €15,000. There are some individual cases-----

Deputy Pa Daly

That is if they are in the redress scheme.

Deputy Mary Butler

That is in the redress scheme. Some individual cases that have gone privately to court do not come under the terms of the redress scheme at the moment.

I will respond to Deputy Shortall on the size of nursing homes and private nursing homes. This is something I was concerned about and we did a huge amount of work last year on a design guide for nursing homes, which has been circulated to the entire sector. We have received information from the sector. HIQA worked closely with us on this.

When a private nursing home applies to a local authority for planning permission, the local authorities are at a bit of a loss because they do not know what best practice is. A huge amount of work has been done by HIQA, along with gerontologists and the Department, to put in place best practice. I do not need to legislate for it. When people apply for an extension to a nursing home or build a new one, they will have to attend a preplanning meeting with HIQA in advance of applying to the local authority.

There are recommendations in respect of best practice. The recommendation on size will be a family model of 84 beds per nursing home. That will not be legislated for, but it is best practice. For example, when a private operator built a nursing home in Waterford recently, HIQA was not able to register it immediately because there was an issue with balconies. If there is best practice before planning permission is applied for, we will not have a situation where further works have to be done to make a nursing home compliant.

We believe this will help the sector and also give an indication of what is required. For example, I want green areas around all nursing homes. During Covid, some nursing home residents were able to have window visits, but those living on a second or third floor could not. We have done a huge amount of work on the design guide. All of the recommendations and feedback we have received are being collated. I hope to announce the guide very shortly. It is important that we have a proper design guide for new nursing homes. It is not retrospective because we cannot put that type of pressure on nursing homes that have already been built.

One other measure announced this year was €10 million in funding to support nursing homes that were not HIQA-compliant. Up to €25,000 per nursing home, backdated to 1 January 2020, is available and many nursing homes have taken that up already. If a nursing home has to be HIQA-compliant in infection prevention and control and fire and safety and did any works from 1 January 2020 - the funding is open until November 2024 - it would be able to claim that money back. That funding is to support small and family-run nursing homes so that when HIQA says a home is not compliant and it might cost €30,000, €35,000 or €40,00 to make a change, €25,000 is available to help it become HIQA-compliant.

An Leas-Chathaoirleach

I propose to move on now. We will take sections one by one. If members could indicate-----

Deputy Róisín Shortall

I want to make another comment.

An Leas-Chathaoirleach

The Deputy may make one more comment but that will be the end of it because we have to show progress. I advise members that if there is a particular issue they want to pursue, they should indicate at this stage their intention to come back to it on Report Stage, as the Minister of State has already set out she will do.

Deputy Róisín Shortall

That is fine. The guideline of 85 beds is fairly reasonable.

Deputy Mary Butler

It is 84 beds.

Deputy Róisín Shortall

Sorry, 84 beds is fairly reasonable but there is no statutory basis to those guidelines. Therefore, they are not a requirement for multinational investment funds, which most of them are now. This is monetising care and the Minister of State and her Government have allowed that to happen over the last four and a half years. The provision of care for elderly people is now much more about extracting returns on investments than providing quality care in a setting that is as close as possible to a family setting. We have moved far from that proper ideal model for older people. The current model is entirely unsuitable. For that reason, I do not know why this is not statutory-based guidance for nursing homes. There is no requirement to comply with the guidelines from HIQA.

Deputy Mary Butler

We were trying to take a carrot-and-stick approach, but the whole point is-----

Deputy Róisín Shortall

There cannot be a carrot-and-stick approach to investment funds. The Minister of State should have learned that from the disasters that have occurred in housing.

Deputy Mary Butler

Some of the comments the Deputy is making are rather disingenuous. I came to this post on 1 July 2020. I am not quite four years in the job yet but that is not the point. The point is that for the first two years in government, we dealt with Covid, which was very challenging in the nursing home sector. I sat on the same committee as Deputy Shortall at that time and we have made a huge number of changes with regard to the expert panel report. This legislation has come from that.

To go back to the design guide, which is very important, there has been significant engagement with the planners in the local authorities and this is what will be recommended. There will be a pre-planning meeting with HIQA before the guide goes to the local authority. The local authorities will be very much guided by what we see as best practice which is a family model with builds of 12 units - 12 single rooms en suite - that will add up to 84 beds.

I recently had a round-table meeting on community nursing hospitals and units around the country. There are 117 of these units, of which 48 have been rebuilt or reconfigured with another 42 still to be reconfigured in order to be HIQA compliant. I have asked for a pause, as opposed to a halt, in building works because I want to increase bed numbers to 84 in cases where we planned to build a 50-bed or 60-bed unit. I want every single unit to have a dementia facility included as standard now. Many but not all units have such a facility. In this way, we will begin to claw back some of the public beds we have lost. I was not happy when I became a Minister of State to find that 80% of beds for older people were in the private sector. I have said that many times and I agree with the Deputy completely on that. We have to start changing the narrative and I am trying slowly to change the narrative in the Department and HSE because we have to build more capacity in the public sector and give people options across all communities. In my opinion, people should have the option of availing of a public, private or voluntary nursing home. Some 11% of our nursing homes are voluntary. There have to be options for people. We know, for example, that residents of community nursing unit will not have to pay any additional charges but residents of private nursing homes will pay additional charges. Ms Laura Casey, our principal officer, and her team have done a huge amount of work on additional charges. We will have a report on the additional charges that are being charged the length and breadth of the country very shortly. I expect the Deputy will welcome that report, which will make recommendations.

There is a huge amount of work going on in the background on additional charges. All nursing home residents, whether in public, private or voluntary homes, are entitled to the supports provided in public nursing homes. There is also work under way on best standards, so there is an awful lot of work coming together. I look forward to publishing it and getting the Deputy's feedback. It will be very important to have a full debate in the Dáil on that element of nursing home care. Many of the debates focus on the amount of money being paid to the private sector. A debate on all of those other elements would be very welcome.

Deputy Róisín Shortall

Yes, a debate would be good but we need action. What is the timeline for the strategy right to home care?

Deputy Mary Butler

I invite Ms Casey to answer that question.

Deputy Róisín Shortall

That is fine.

Ms Laura Casey

Is it the legislation around the regulatory framework?

Deputy Róisín Shortall

No, the statutory right to home care.

Ms Laura Casey

As the Deputy will know, the Bill is the regulatory framework. There is a parallel piece of work about the funding of home care and that work is ongoing within the Department.

Deputy Róisín Shortall

What does it mean that the work is ongoing? We have been waiting since 2018 for a statutory right to home care.

Deputy Mary Butler

I am concerned about this because when statutory home care was announced by the previous Government, the perception was that statutory home care would be like nursing home care in the home. That is not the way I see it because we would not have enough carers to deliver it. My budget for home care this year is €730 million. The nut has not been cracked yet as regards at what stage people would contribute to the cost of home care, notwithstanding that we have had reports from the Economic and Social Research Institute, ESRI. That is the concern I have. For example, in the case of people who receive home care of up to 14 hours free at the point of entry, at what stage will they be charged under a mechanism similar to the fair deal scheme? I would be happy to meet the Deputy to discuss this. That part of the equation has never been finalised and it is the piece I find hardest to grapple with. The ESRI has looked at charging, say, €5 per hour for home care and various other issues. If home care is to be like nursing home care, people will be expected under a means test to contribute. How do we decide that? I have a budget of €730 million for home care this year. If we say to people they can have 14, 16 or 18 hours of home care free of charge but if they increase that to 20 hours they will have to pay, people will obviously choose 14 or 16 hours. For me, that is the issue. We have not resolved that part of the equation yet and that is the point I find difficult to grapple with.

Deputy Róisín Shortall

With due respect, it has been six years and that nut has not been cracked.

An Leas-Chathaoirleach

I have to move on.

Deputy Róisín Shortall

It sounds like we are not anywhere near to having the legislation.

An Leas-Chathaoirleach

Excuse me for a minute. I want to move on and show some progress on the subject matter before us. As we come to each section, if members indicate that it is their intention to introduce an amendment on Report Stage, that would be fine. The Minister of State has already indicated it is her intention to do so.

Sections 1 to 12, inclusive, agreed to.

SECTION 13

Question proposed: "That section 13 stand part of the Bill."

Deputy Pa Daly

I wish to advise that we may table amendments on Report Stage.

Deputy Mary Butler

Noted.

Deputy Róisín Shortall

I may do so as well. It depends.

Deputy Mary Butler

Noted.

Question put and agreed to.

Sections 14 and 15 agreed to.

SECTION 16

Question proposed: "That section 16 stand part of the Bill."

Deputy Pa Daly

There has been a previous concern. I noticed that in County Kerry that the Cois na Féile service has been closed down, which is a big disappointment for the families who used the facility. A concern had been flagged by HIQA that its enforcement powers were too blunt, that the introduction of compliance notices would be a welcome step so that the nuclear option of closure would not have to be flagged and that a more graduated report may be necessary. We may come back to that issue on Report Stage.

Deputy Mary Butler

I met Ms Carol Grogan, the chief officer of HIQA, recently. She is very happy with the contents of the Bill to date. She also used the same wording - that the tools were very blunt - but this will allow her to deal with more urgent cases, working alongside the providers. She also flagged that there was repeated non-compliance across some services. This legislation pertains not only to nursing homes but also disability services. Ms Grogan felt that compliance was not being taken serious enough at times. The change in the timeframe from 28 days to 14 days will give the chief inspector much more power. I agree with the Deputy.

Deputy Pa Daly

That is noted.

An Leas-Chathaoirleach

That is noted for future reference and the next Stage.

Question put and agreed to.

Sections 17 to 32, inclusive, agreed to.

SECTION 33

Question proposed: "That section 33 stand part of the Bill."

Deputy Mary Butler

Sections 20 to 33, inclusive, are all technical amendments to the Nursing Homes Support Scheme Act for more complete cross-reference. I wish to flag that section 21 is to amend or extend the family successor to include first cousins, great-nephews, great-nieces and great-grandchildren. I will introduce an amendment on Report Stage to include various levels of cousins to make sure that a bachelor farmer or farmerette who may only have a first cousin of his or her own age would not be excluded from the scheme.

Deputy Gino Kenny

I have never heard the term "farmerette" before.

An Leas-Chathaoirleach

One hears strange things here from time to time. Deputy Shortall has already spoken on the issue she wants to raise on Report Stage and that is noted. The Deputy has also raised the same and similar issues. That is noted.

Deputy Denis Naughten

I apologise. I am running between committees and the House.

An Leas-Chathaoirleach

I noticed that.

Deputy Denis Naughten

I want to ask one question about the definition of "relation". As the Minister of State will know, we have been dealing with a number of cases regarding the nearest living next of kin who are beyond first cousins. The legislation, as currently drafted and presented on Second Stage, only facilitates accommodating the transfer of land to first cousins. That provision is insufficient to deal with situations which, sadly, exist in many parts of rural Ireland. In the two cases I am dealing with, the next of kin is actually a first cousin once removed. That is the nearest living relative and they are actively farming the land. Can the legislation reflect the practical reality of what is happening in rural Ireland?

An Leas-Chathaoirleach

The matter has already been alluded to. The Minister of State will reply.

Deputy Mary Butler

Over the last 12 to 18 months, there has been constant interaction between Deputy Naughten and me on this issue, which is an important unintended consequence of the legislation that was moved. When the legislation was drafted it included a reference to a first cousin, great-nephews, great-nieces and great-grandchildren. I discovered very quickly that a person's first cousin could be the same age as him or her. It will now be first cousin, first cousin once removed, first cousin twice removed and first cousin thrice removed.

Deputy Róisín Shortall

That covers half the country.

Deputy Mary Butler

I will table the amendment on Report Stage. The provision was suggested by Deputy Cahill as well because he had come across similar cases.

In order for a farmer, landowner or business owner to avail of the three-year cap, he or she must appoint a successor. The successor must be a member of his or her family. The successor does not have to be the person who will benefit from the person's will. There is a only a small number of bachelor farmers but I had three cases where people were not in a position to enter a nursing home because they were not able to appoint a successor under the current legislation. We will certainly make sure this matter is dealt with on Report Stage. Where a bachelor farmer is, say, 80 years of age at the moment, his cousin will be of the same age so obviously could not be appointed as successor. A reference to a first cousin once removed, twice removed and thrice removed will be included to deal with this scenario. I thank the Deputies for their work on this matter.

Deputy Denis Naughten

I thank the Minister of State. I appreciate that.

Deputy Róisín Shortall

Can a third cousin twice removed inherit a house in an urban setting?

Deputy Mary Butler

I honestly do not know. I suppose anybody can inherit if a property is left to them in a will. The new provision concerns appointing a successor to manage the holdings while a person is in a nursing home. First cousins, great-nieces, great-nephews and great grandchildren were the only persons included in the legislation whereas previously the provision had been more limited.

Deputy Denis Naughten

To clarify, the tax code does not change in relation to this matter. People will still be treated as non-relatives under the tax code.

Deputy Mary Butler

Yes.

Deputy Denis Naughten

Whether you are urban or rural, you would be treated the same. The difficulty is that we have people who cannot go into nursing homes, or people who are in nursing homes and their successors are farming the land and paying out from the income from the land in order to keep them in nursing homes, which was never the intention of this legislation. It is a small cohort of people but it is causing huge hardship for those families who were are trying to keep in rural Ireland.

Deputy Mary Butler

I agree wholeheartedly with the Deputy. It was an unintended consequence of the legislation introduced two years ago but this will rectify it.

Question put and agreed to.

Title agreed.

Bill reported without amendment.