Marian Harkin (Sligo-Leitrim, Independent) | Oireachtas source

I am sharing the last three minutes with Deputy Fitzmaurice. Yesterday, at the start of my intervention, I welcomed this Bill and I thanked the Minister of State for bringing it forward. It is good legislation which protects the productive income from the farm or business and that is what is most important.

My understanding is that if someone has been in care for over three years, once he or she appoints a successor, he or she will no longer have to pay the 7.5% contribution based on his or her asset. If someone is in care for two years and ten months and appoints a successor, does he or she have to pay just the two months or the entire three years to bring it up to the three-year cap? I do not know the answer to that question and I hope the Minister of State will clarify this for me in her reply. I hope it is the latter case.

I want to return to an issue I have spoken about before, which is the increasing challenges being faced by private nursing homes, especially some smaller ones in rural areas. We are talking about a fair deal, so it has to be a fair deal for everybody. The average weekly fee in 2018 for public nursing homes was €1,564, whereas it was €968 for private nursing homes. I recognise in some specific cases, those with more complex needs may be more likely to be cared for in a public nursing home. Nonetheless, the vast majority of people are being cared for in their locality.

In my constituency, public nursing homes cost the State 60% more in County Sligo, 68% more in County Leitrim, 70% more in County Roscommon and 81% more in County Donegal. All nursing homes, public or private, must operate to the same standards and I am not, for one instance, suggesting we pay public nursing homes less, but we have to look at paying private nursing homes more.

Back in 2015, a review of systems for setting prices under the nursing homes support scheme was set up by the then Minister for Health, Deputy Varadkar. It was supposed to report back in 2017. Before Christmas, I asked the Tánaiste why that report had not been published. I still do not know why, and it still has not been published today. Why is that? It seems fundamentally unjust to commission a review of pricing policy in the sector in 2015 and to leave nursing home owners waiting on its recommendations six years later. It was needed then; it would not have been commissioned if it was not.

The truth is that many of those private nursing home owners are barely hanging on. I have spoken to many of them in my constituency and they are under serious pressure financially. They cannot compete with the HSE when it comes to terms and conditions for their staff, even though they want to do so because they have top-class staff. They have difficulty in retaining staff. If some of those nursing homes close, the State will have to step in, which will mean greater cost to the taxpayer. Foreign investment is already coming into the sector. I am not saying it is like the housing sector but there are parallels. That is not negative in itself but it changes the dynamic. We need to take a more holistic view of our procurement model and we must never equate value for money with a race to the bottom. I am not saying that is happening; I am just sounding warning bells.

I ask the Minister of State to publish the review of the systems for setting prices under the nursing homes support scheme. I have given plenty of anecdotal evidence about the need for that review to be published and acted upon, and I am sure other Deputies will do the same, but I am not just relying on anecdotal evidence. I have read HIQA's yearly overview reports and what they say is very clear. The 2017 report notes:

In 2017, five registered providers advised HIQA that they had made a decision to close their nursing home. The five nursing homes [were] all small centres with less than 40 residents...

In 2018, HIQA stated that "smaller nursing homes — which often provide a more homely environment — are closing voluntarily due to concerns over their financial viability." The 2019 report read:

The nursing home sector in Ireland has changed considerably in terms of the size of new centres ... [and many of] these new centres are largely concentrated in the east of the country, particularly in Dublin. At the same time, smaller centres are closing across the country, presenting a challenge to rural communities.

It is happening. We need a vision for the sector and that vision must be underpinned by the resources necessary to deliver it.

See this speech in context