Seán Sherlock (Cork East, Labour) | Oireachtas source

I support the motion. I am glad we are debating this matter tonight. I read the Minister's speech and listened to him speaking earlier. He spoke about the NTPF and said that any nursing home that "has had a scheduled renegotiation of its deed of agreement this year with the NTPF has seen a significant uplift" and that the uplift has been in the region of 6% to 7% above the baseline price for the weekly rate charged per resident. To date, over 120 nursing homes have renegotiated their contracts with the NTPF. Many nursing homes are telling us that the uplift is not keeping pace with inflation and that therefore they are still operating at a real time loss in terms of their overheads and costs that accrue to nursing homes arising from their day to day operations. The statement by the Minister needs further interpretation based on my experience of talking to the so-called mom and pop shops. That is an American aphorism that is used. It normally refers, with all due respect to the Minister, to somebody who has a café employing two or three people but I am talking about entities that are businesses, inter-generational family-run businesses employing anywhere from 30 up to 100 people, or 150 people in one case. They are not mom and pop type operations. We need to be careful about the language we use so that it is not patronising or diminishing anyone in any way. I know the Minister is not seeking to do that.

We have to speak for people like Angela Liston, for instance, from the Youghal and District Nursing Home, who wrote to me to say "we are currently barely keeping our heads above water" due to the ongoing crisis in the funding of nursing home care under the fair deal scheme. Her nursing home is currently receiving €1,040 per week per resident whereas the local HSE community nursing home is €1,697 per week per resident. That disparity between a public and a private nursing home is something that we need to interrogate further.

What I do not have on this side of the House is transparency with regard to the model that determines the cost or amount that is allocated per resident per week. We will be told there is a higher rate of dependency among those in the public system. I have not seen evidence of that or research on it. The people, including Angela, in the Public Gallery want some form of equalisation. They cannot wait for the review or scheduled renegotiation to be able to get that 6% or 7%. They want to know whether there will be equalisation across the system to bring people who are on the lower scale up. As her public representative, I need to know how the review of pricing will get to that point.

My fear is that the intergenerational businesses will decide to sell on to the larger corporate entities, which have economies of scale and can mobilise people. The Minister referred to that. The intergenerational businesses will sell up and get out of the business and, before he knows it, the Minister will be dealing with three or four entities that are owned by fund managers and they will have the Government and the NTPF over a barrel. I ask the Minister to please allay my fear when he replies. Protections should be given to people such as Angela. I refer to Angela, but the same is true for hundreds of businesses throughout the country.

I am taken with the concept that allows for the principle of force majeure to be built into the system such that a nursing home would be given its price per resident on day one of the agreed negotiation. When external shocks or negative externalities, such as a massive increase in inflation or increases in energy costs, occur, a built-in force majeure mechanism would allow people such as Angela to go back to the NTPF and tell it their business cannot wash its face because of the massive impact of things such as inflation. A mechanism to allow for leeway or headroom in that regard would be welcomed by the nursing homes to which I have spoken. If the State introduces an additional bank holiday, national wage agreement or statutory sick pay scheme, for example, that will need to be factored in. In light of the level of dependency on long-term residential care entities, there needs to be a mechanism to allow for additional funding for nursing homes within a certain category and size to cover overheads arising from legislation passed by this House. I take the point made by the Minister in respect of the large corporate entities that have economies of scale. A mechanism could be found in the pricing mechanism to give alleviation to people like Angela. That is the fundamental point I wish to impart this evening.

The Minister of State, Deputy Butler, is well aware of the demographic pressures the country is facing. CSO figures indicate that, six or seven years from now, there will be 1 million people over the age of 65. Unless we tackle this issue now, we will face a cliff edge in the context of care for older people. I know the Minister of State is acutely aware of that and seeking to plan for that future. It is clear, however, that transparency regarding how a price or amount in respect of an individual, whether in the public or private system, is arrived at would help. If one goes through the HSE list of nursing homes under the nursing home support scheme and looks at centres in Carlow, Galway, Cork and Donegal, one will see the differences are massive. They are not just based on geography. There are massive differences within counties as well. For instance, my community hospital receives €1,859 but the Breffni Care Centre - I am not familiar with it and have picked it at random - in County Cavan receives €1,999. I do not understand the differentials and how they are arrived at. To go back to Angela's case, she needs to know why there is a difference of €657 between her business and the local nursing home. Nobody has been able to explain that through research. The logic that applies in rhetoric and in the public domain is that there is a higher level of dependency in community nursing homes but, as a layperson, my first-hand experience is that there are high levels of dependency across the private realm as well.

I want businesses such as the Youghal and District Nursing Home, run by Angela Liston, to be able to survive. I do not want smaller nursing homes to disappear from communities. If they disappear and nursing home care is corporatised, we will be going down the wrong road. Through the introduction of small and incremental changes, businesses such as the one run by Angela could be allowed to survive and thrive and continue with the ethical and local model of care she has provided for all her professional life.

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