2026-02-19

This Topical Issue is to discuss supports available to vulnerable children and adults in County Wexford who suffer from a disability. Families with children and adults with disabilities are in crisis in terms of the supports and carers that are made available to them. I was contacted by a distressed and exhausted mother who has three children with serious disabilities. She is literally at her wits' end. She has a 25-year-old, a 22-year-old and a 17-year-old. They all have very complex medical needs, including intellectual and physical disabilities. A home nursing package was sanctioned by the HSE many years ago. First, it was through the Nurse on Call agency. It was then transferred to another agency, which I will not name. The woman in question said she has had the pleasure of meeting and working with many exceptional nurses. However, in recent times, the quality of nursing has drastically deteriorated overall. She puts this down to a number of factors, including nurses being put in positions outside their level of expertise. ICU neonatal nurses, following a four-week induction, are being placed to care for her three adult children with very complex needs. The HSE passed the buck constantly. Any time she questioned it, it said the agency managed the package. The HSE will not interact in any way, shape or form. The management and the director of nursing in the HSE will not meet to discuss the issues with the parents. Instead, parents have to speak with a liaison nurse who then refers them to management. There is no governing body over home care packages. For example, she has been asked on a few occasions by different nurses how to turn on a portable bottle of oxygen, among other basic nursing questions. None of the nurses she has been supplied with through the agency - this is not the nurse's fault but the HSE's fault in terms of governance - have ever used a hoist prior to coming to her house to, as she puts it, "allegedly" care for her children. She provides the training. The woman has made recommendations to the agency and the HSE in relation to the training of these nurses prior to coming to work in this area in terms of induction. Of course, the HSE is washing its hands. Believe it or not, the agency is paid €18,650 per week to provide the care package. The nurses get €18.50 an hour. The private company gets €74 an hour per nurse. That is just shy of €1 million per year for providing the care. When a risk assessment was done, the recommendation that came back from the agency was that it needed more nurses on top of the €18,650 a week it was getting. This is indicative of so many of the problems in this country arising from privatisation, particularly of care. Here we have an agency that is literally creaming off the top and making massive profits. It appears to be the only agency providing this type of care in County Wexford. It is receiving just shy of €1 million per year for one home for three children, but it is not paying the nurses a proper wage. As a result, it is getting nurses who are not suitable or qualified in this specific area. They are excellent nurses in their own right and in their own areas, but they are not suitably qualified to provide the level care. This is replicated in many other instances across Wexford, according to the information I have been given. It is something that we have to investigate given the level of public money going into these private agencies. This case is indicative. The matter has to be urgently examined.

I thank the Deputy for raising the issue. He has outlined a specific issue on the floor of the Dáil. I do not have the exact details of the case, but I will speak to it. If the Deputy could furnish the details afterwards, I will certainly do what I can to help. The woman the Deputy spoke about is doing extraordinary work. She has a 22-year-old, a 25-year-old and a 17-year-old. Looking at the sums the Deputy quoted, we seriously have to ask ourselves whether we are getting value for money. More importantly, are we getting the care for people that the State is paying for? That is the most important question here. In my time as Chair of the disability committee in the last Dáil, I met many families and saw the challenges they face on an ongoing basis. Since my appointment to my current role, I have sat on the Cabinet subcommittee on disability and we have had many discussions on funding mechanisms, the challenges that are there and the amount of money we are paying to private agencies to provide public care. The real challenge is determining whether we are getting the care required. We can talk about value for money after that but the most important thing is the care that is required. I hear the Deputy's frustration in speaking about that mother, the hoist, the oxygen and the other challenges. He has described young adults who have a multiplicity of very complex needs. What that mother is doing is a vocation for her. I do not have the full details but I will certainly take the details from the Deputy if he will give me them. We have a shortage of respite and residential spaces across the country. We are spending a huge amount of money. Again this year, the amount of money being spent on the disability sector has gone up by a huge amount to try to make sure we are doing the right thing by people with disabilities. There is serious engagement at Government level on the matter. However, we also have to be mindful of the existing system we have built up. Is that right for families? We must stand back and ask what we can get for €1 million. The figure the Deputy mentioned is extraordinary. Deputy Lawlor has outlined that woman's serious concerns about the level or quality of care. I will personally take up the matter. I will engage with both the HSE and the Minister on the Deputy's behalf. I ask him to forward me the details privately. I do not want to comment on the case publicly but I will certainly engage privately.

I have not mentioned the family or the company involved. The Minister of State is quite right in saying that this lady's care for her children is a vocation. I have worked with her over many years and her dedication and commitment to her children, who have profound and complex needs, is just remarkable. She is now exhausted and distressed. She has been fighting for a long time. If the Minister of State will believe it, she actually did some of the training for some of the nurses who came in. She showed them how to work various pieces of equipment. Given the level of investment, this is incredibly frustrating to this family. That level of investment could be justified if they were getting the quality care that figure demands. Without meaning to put a price tag on anything, we are paying an agency whose only aim is to maximise profits, as we have seen in myriad sectors across Ireland. The moneys involved, which are almost being demanded by these agencies, are off the charts. As the Minister of State has suggested, the money being invested in the area of disability has gone up hugely but that is because we have to meet these bills. Imagine what a proper caring agency run by the State could get for that €1 million. We would be able to pay nurses and train them properly to the highest standards rather than forcing people into these positions. In many instances, we have no choice because the nurses are not there. They are not there because we are not remunerating them as we should. As I have said, €74 per hour goes to the agency while €18.50 goes to the nurse. That is criminal in the context of what the State could get back if that money went into a properly structured HSE-run agency.

The case the Deputy has outlined is extremely disturbing. At the core is the care that is being provided and the concerns of the mother, who has a vocation, about the care she is getting. That is one side of it. The other side of it is the amount of money the State is spending and that figure of €74 versus €18.50. A lot of section 38 and section 39 organisations around the country have invested and provided care for people with disabilities for many years. They have provided massive value for money. Every cent they have is invested into either community facilities or the teams that work in them. People should not be financially benefiting from the care of very vulnerable people. The funding the Deputy has outlined has come up at a number of the meetings, as have privatisation and some of the organisations that are providing care and charging the State an arm and a leg for it. These things have come up because we need to get the best value for money. However, we also need a level of faith in the system and in the care that is being provided. We need families to have faith in that system as well. I will take up this issue. I will certainly engage with the Deputy on it because it is hugely important that we follow this up for the family the Deputy has mentioned, for the State and for other people who need the same level of care and who are experiencing similar engagements with private companies. I will certainly do that.