It is 20 years since we saw distressing footage of conditions at Leas Cross nursing home. Here we are again. The scenes on last Thursday's "RTÉ Investigates" programme were deeply disturbing. Aoife Hegarty's team exposed horrifying practices in nursing homes run by one of Ireland's largest private care providers. I commend the RTÉ team and the whistleblower, Clare Doyle, on exposing those abuses. We saw awful footage of older people being pushed around, forgotten, abandoned and calling for help from their beds or after a fall. Often, residents were left to soil themselves and there were shortages of basic equipment like hoists, sanitary wipes and gloves. We saw staff making makeshift bedsheets out of incontinence pads.

Older people are being demeaned, degraded and dehumanised in some private nursing homes, and profiteering is at the root of this. Some 80% of Irish nursing homes are private or voluntary and shockingly, just ten investment funds own one third of all nursing home beds in the system. An influx of investment funds in recent years has left our country with the most privatised system of care in the EU. Big corporations are profiteering from, in some cases, negligent care of older people who are mistreated in private homes, so that companies can make a quick buck.

The residents of Leas Cross, of Beneavin Manor and of many so-called care facilities have, over the years, paid a high price for State tolerance of an unacceptable status quo. If we are honest, can we truly say we are shocked? I acknowledge some things have changed since Leas Cross. HIQA was set up to set the standards, to inspect and, indeed, to shut down non-compliant nursing homes, public and private. What we know now is that HIQA is clearly failing in this duty.

When families are reviewing a particular nursing home for their loved ones, the first thing they do is check the HIQA report. That is what the family of Audeon Guy did. Families, in relying on information from HIQA, may unwittingly be putting their relatives in harm's way. Clearly HIQA practice is unfit for purpose and must be reviewed urgently. The Minister for Health needs to explain why it is HIQA that is now being called upon to conduct the so-called independent review of all nursing homes. That is particularly strange after it glaringly failed to identify abusive practices at Beneavin that some journalists and a carer with a camera found.

This was not an isolated incident. We are all hearing this. I am aware of one nursing home employee who has not received so much as an acknowledgment of her complaint to HIQA, five months after she submitted the complaint. Another person who contacted me was told by HIQA that it would not investigate the care received by her now-deceased mother and the ombudsman would not investigate. It was a substantial complaint. Among other things, there was an unforgivable failure to provide her mother with necessary medications.

We need to urgently review the system. Has the Taoiseach confidence in HIQA's ability to review nursing home care in Ireland and how can families have any level of trust in HIQA reports having seen what we saw last week?

I thank the Deputy very much for raising this issue. It is a very serious and shocking situation. The revelations on "RTÉ Investigates", in particular, must have been deeply traumatic for families with loved ones in nursing homes generally but particularly in the two nursing homes that were covered by "RTÉ Investigates". It is particularly concerning that the regulatory authority did not capture or unearth this, particularly in one nursing home, in terms of its reviews. HIQA, when it was established, came out of Quality and Fairness, the health strategy in 2002. I was involved in it at the time, setting it up on an interim basis. Prior to that, we did not have a quality authority in health. It has done a lot of impactful and effective work over the years, but this is deeply concerning. There has to be a review by HIQA itself too, in terms of what went wrong here and in terms of not revealing what was subsequently revealed.

I pay tribute to the "RTÉ Investigates" team on this. Methodologies may have to change in relation to inspection. Penalties also have to be reviewed in terms of either fines or, indeed, closure. Closure creates its own issues in respect of alternative locations but there have to be real consequences for horrific treatment of senior citizens in this manner. That is something I believe in. The family of Audeon Guy have spoken eloquently and very distressingly on their family situation and their acceptance of and belief in the impartiality of the HIQA reports as they checked the record of given homes following the inspection reports.

On our overall system, there is the public service sector side of it in which we invested significantly in the last number of years but a lot of that investment was in modernising and refurbishing district hospitals which had been on a list for quite a long time in terms of the necessity for refurbishment. The HSE works with certain homes in providing HSE beds, particularly for dementia cases where extra and additional supports are required. Home care has also expanded enormously. In the last four years alone we have doubled provision in home care from about €400 million to €800 million and consequently added additional hours and so on. I will come back on this later.

I listened carefully to the answer but I did not hear anything substantive about what the Taoiseach and the Government propose to do following on from those shocking revelations. It is not just about HIQA failures. This is also about ensuring older persons have a voice. There is a blueprint there. We have a Law Reform Commission report from last year about setting up an adult safeguarding framework. Safeguarding Ireland last week again called on the Government to initiate a process which would lead to the enactment of this necessary legislation which would challenge that culture of systemic ageism. We have to call it out. It is that culture that has enabled the growth of this appalling for-profit system that has facilitated the carrying out of abuse on vulnerable older citizens. All of us are hearing from older persons who are so fearful now about their own futures and those of their relatives, given the lack of safeguards in the system. Will the Government adopt the process that Safeguarding Ireland and the Law Reform Commission have so clearly set out about adult safeguarding legislation and ensuring older persons are protected?

Yes, the Government has made that clear. We will be doing that. It is in the programme for Government. There is a forthcoming national policy on adult safeguarding for the health and social care sector that will set out how existing protections will be strengthened. That will be brought to Government shortly-----

When?

-----and that will commit to the development of adult safeguarding legislation for the sector. We have included the health (adult safeguarding) Bill in our current legislative programme to facilitate this. On a more broader sense, we are looking at a combination. I am trying to be realistic here and respond meaningfully to what the Deputy has articulated. I do not disagree with a lot of what she said. However, there will be a necessity for increased public sector provision, for continuing private sector provision and increasingly more home care provision, a significant amount of which will be private. Regulation of both public and private will always be key here but I believe there should be a rebalancing with more public service provision, particularly in the context of more acute situations around dementia and so forth. We might get an opportunity to discuss this in greater detail later.