Mary Butler (Waterford, Fianna Fail)
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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.