Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I welcome this opportunity to address the House and thank the Deputies for tabling what is a largely sensible motion, bar one piece in it which does not make sense to me at all and which I will come to at the end. Broadly, however, I think the motion has been tabled in good faith and it is a very sensible motion. On that basis we will not oppose the motion. It is an important opportunity to debate these issues.

As Minister for Health and a citizen of our Republic, I am deeply appreciative of the care services provided right across this country - in every one of our constituencies, in every county, in every town. I recognise the extraordinary work, the compassion, the dedication and the professionalism of those working in our nursing homes every single day, every single night, taking care of some very vulnerable residents, some of whom colleagues have given examples of and have read out testimony from. I also acknowledge the dedication and the leadership of the Minister of State, Deputy Butler, which I know is broadly acknowledged around the House. I have the great honour and privilege of working with the Minister of State and have done for the past three years in office. I have never seen a Minister more dedicated, more passionate or more resolved to ensure older care in this country is fit for purpose, fit for our Republic and something we want to see get better and better.

Colleagues, I hope, will acknowledge that there has been an unprecedented level of investment in older care, in the nursing home sector and in health generally in the lifetime of this Government. To be clear, last year €1.4 billion of public money was used to support nearly 23,000 women and men under the fair deal scheme. This year the figure will be approximately €1.5 billion. It is a vast amount of money - public money - going to support these places, and quite rightly. The Government, during its lifetime and through Covid, as well as providing that €1.5 billion, has provided very substantial additional funds, and quite rightly. In excess of €150 million was provided through the Covid-19 temporary assistance payment scheme, TAPS. An additional €10 million was provided through the temporary inflation payment scheme. On top of that, as colleagues will be aware, the State is covering the costs of personal protective equipment, PPE, and oxygen to private nursing homes. It may surprise colleagues to hear that the cost of that to date is €75 million. Therefore, on top of the €1.5 billion under the fair deal, hundreds of millions of euro are being provided directly to nursing homes in financial aid from the State. The investment is very clear, tangible evidence of this Government's commitment.

I will update colleagues on some of the other measures going on and on which the Minister of State, Deputy Butler, is leading. The patient advocacy service was extended to private nursing homes last November. Revised regulations have been in place since December. Those regulations enhance and streamline the complaints process which came into effect in March of this year. The results of the first nursing home care experience survey were published last November, and I know colleagues will have looked to that. In conjunction with the HSE, recruitment has commenced for new dedicated infection prevention and control and safeguarding specialists for our nursing homes. On top of that, new training and development opportunities are being rolled out for staff working in nursing homes with a new palliative and end-of-life programme. That was launched last year. I know we all agree on the huge value that palliative care and end-of-life services are providing in nursing homes and in other services throughout the country.

Let us come to the National Treatment Purchase Fund, which goes to the core of the motion we are debating. As regards the funding of nursing homes, it is important to note that all private and voluntary nursing homes must agree a maximum price they can charge to a fair deal resident. They do that with the National Treatment Purchase Fund, which is the designated State agency.

These prices are agreed with the National Treatment Purchase Fund, NTPF, following negotiations and are based on cost criteria such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. The NTPF carries out this role independently under the 2009 Act. It has statutory independence. Deputy Gould referenced what Sinn Féin would do in government, and he is right to say so, but he should be aware that Sinn Féin would be statute-barred from interfering in any individual negotiation. For reasons we all understand, the NTPF has statutory independence in those negotiations.

Any nursing home that has had a scheduled renegotiation of its deed of agreement this year with the NTPF has seen a significant uplift. Nursing home providers I have spoken to directly have stated that, when they got the uplift, they reached a much more sustainable financial position. They stated that, before the uplift, the cost of living had exceeded their cash flow and that, once they got the uplift, which amounted to 6% or 7% in most cases, it made their organisations and businesses financially viable. To date this year, more than 120 nursing homes have renegotiated their contracts with the NTPF. As colleagues will be aware, that is happening on a rolling basis.

There is an additional and welcome reform. Under it, nursing homes can now accept 12-month contracts rather than three-year ones. This speaks specifically to their reasonable concerns about the inflationary environment in which we are.

I wish to discuss nursing home closures. While I accept the good faith of colleagues across the floor, one could be forgiven for thinking that, based on the contributions we have heard so far, the total number of nursing home beds in the country was reducing. It might come as a surprise to people who are watching the debate to know that the total number of nursing home beds in the country increased last year and has increased again this year. To date this year, there have been an extra 185 beds. We expect that number to keep increasing.

Deputies have rightly pointed to nursing homes that are closing. I have great sympathy for certain cases, for example, a mom and pop operation that has been in the family for years and is totally dedicated to the care of its residents but that, due to inflationary pressures, what has happened with Covid, the jobs market and many other reasons, has found itself unable to continue its services. There are other nursing homes that are very well capitalised and whose ultimate corporate objective under law is to maximise shareholder return. There are nursing homes that are not complying with the HIQA standards. We would all agree that every nursing home must comply with those standards. I accept fully that there are nursing homes that are closing and that, in some cases, they are services in the community that we would dearly love to see being sustained.

Deputy Gould referenced a particular nursing home. Like him, I feel for its residents. However, may I respectfully suggest that he direct at least some of his outrage towards the private company that told the residents that they might have to leave within 30 days? It is a well-capitalised private company that has nursing homes around the country. It is not some mom and pop operation that found itself unable to do anything other than give those residents short notice. By all means, the Deputy should direct some of his ire and criticism at the Government - that is part of his job - but I suggest that we all focus on the nursing home provider that has caused its residents a great deal of concern. My understanding is that the residents were told they might have to vacate in a brief period. Let us remember that as well.

A pricing review is under way. My Department has facilitated a review of the pricing mechanism for long-term residential care. Recommendations have been received and implementation of those is under way.

As colleagues have rightly pointed out, a core focus for the Government is addressing workforce issues. There are nursing homes that are struggling to hire the healthcare assistants, nurses and other staff they need. An interdepartmental group was put together in March of last year and has made 16 sensible recommendations covering the issues that the Deputies have raised. Implementation of those is under way. Alongside this work, a process of engagement to examine the pay of workers in the community and voluntary sector - section 39 organisations - is under way. The commission on care has been referenced by colleagues opposite. We plan to have that established this autumn. It will be essential.

We are all agreed on the need for our Republic to provide appropriate and fit-for-purpose care. The one area where I was taken aback by the motion was where it suggested that the State deliver and fund a national pay agreement. I imagine that would cost well in excess of €1 billion. I do not imagine that Deputy Cullinane is suggesting that the State underwrite the wage.

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