Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

This is an ongoing issue. It was raised by Nursing Homes Ireland, which held a very well attended briefing in Buswells Hotel some time ago. It has followed up with meetings in the Dáil recently in order to highlight the issue. The message it is sending is that unless this issue is addressed in a timely, professional and effective way, the situation is going to worsen, with dire consequences for those in need of nursing home care. We know, from the statistics provided, that Nursing Home Ireland has over 350 nursing homes in the private and voluntary sector in the Republic, with a further 91 in Dublin. That translates into 17,000 beds and over 20,000 staff. It is also the case that 80% of long-term beds are provided through the private and voluntary sectors, with the other 20% provided by the public sector. The former are making a major contribution. The crisis began with a number of closures of smaller nursing homes.

HIQA was very complimentary about these small, homely, family-run services. The nature of service provided is high quality. It is 24-7 and professional, meets the clinical, social and dietary needs of the residents and provides activities. The services play a role in the discharge of hundreds of patients from hospital beds, which is important given the serious situation in that area. There are four areas which need to be addressed, the first of which is the charges levied. The difference between public and private in this respect is astounding. Public rates are €896 at the lowest end to €2,399 per resident per week at the higher end. In the private voluntary sector, rates are between €765 to €1,355 per week. There is an obvious discrepancy there and it must be addressed. A review of the system for setting up nursing home prices under the nursing home support scheme is awaited. A fit-for-purpose model for charges is needed. The review was due in June of 2017, yet it is still outstanding. Replies to parliamentary questions indicate that it will be released soon; perhaps the Minister of State could tell us the date in her reply. There is a discrimination within the fair deal scheme that has to be addressed. A provider informed me that they are not-for-profit organisations, but they are not for loss either.

Staffing is another issue. There is a crisis in the context of recruiting healthcare assistants. The shortage, if it persists, will lead to closures. Nursing Home Ireland is asking that the role of the healthcare assistant is removed from the ineligible category of employment permits list. New categories have been introduced to answer shortages in various crafts and trades; why can this not be done for healthcare assistants? Private and voluntary bodies are training the healthcare assistants, who are then moving on to hospitals.

There is a major issue with regard to what agencies are providing. Agencies are supposed to be for emergencies, but the rates of pay I have seen are €31.50 per hour between 8 a.m. and 2 p.m., €35 per hour between 2 p.m. and 8 p.m., €75 at night and up to €150 if there is an emergency. One can imagine the amount of money that is being spent on agency staff. I am not sure how much goes directly to the staff - I am sure some goes to the agency - but this creates a big problem. Why would anybody work in either the private or the voluntary sector? It was stated that agencies are killing the health system and they have been described as a costly disaster. In a number of nursing homes, nuns provide the services. Their work, of course, is unpaid. Nuns are an ageing breed; they are not going to be available forever, which presents another staffing issue.

Nursing homes have qualified nurses on their staff, yet those nurses are not allowed to put in intravenous drips. That should be looked at. Nurses should be able to do that in nursing homes so that patients do not have to be brought to accident and emergency.

The Minister for Health, Deputy Harris, had certain things to say about the GMS contract - I will not read out his comments - but the current contract means that access to GP services for nursing home residents is constrained. Nursing Home Ireland is calling for a new GMS contract to include specific reference to nursing home residents. This is needed now, not next month. If residents have access to GP care in the nursing home it means that they do not have to go to accident and emergency, which can be a long, difficult process, particularly for elderly people with Alzheimer's or dementia.

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