Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I welcome the opportunity to address the Houses on the issues raised by the Deputies tabling the motion. I want to acknowledge the contributions from all Deputies across the House this evening.

My only focus and motivation is to ensure that our older population has access to safe, high-quality and regulated long-term residential care services in a timely manner. In order to avail of this care, the majority of people access this support through the nursing home support scheme known as fair deal. Fair deal was designed to protect and support vulnerable older people, and to ensure equal access to nursing home care based on what they could afford. That is what fair deal is all about. This gives certainty to people and their families.

This morning I visited St. Joseph's, Shankill, a dementia-specific facility that is delivering Trojan care under the butterfly model. I then moved on to Leopardstown Park Hospital, and I met more residents there who are under the care of that fantastic hospital. All the residents I met today were there because of fair deal. Government funding for fair deal is to support vulnerable older people at a time in their lives when full-time care is essential.

This is a very difficult decision for people and their families and often takes place at a time of crisis and is a decision that is not to be taken lightly.

Supporting the nursing home sector is a priority for the Government. This year, €1.5 billion will be allocated to support 22,700 residents in nursing home care. To put this in context, this is larger than my entire mental health budget and the entire budget for the South/South West Hospital Group.

While our population is growing and ageing, Ireland has the highest life expectancy in the EU as determined by the World Health Organization. It is important that we can provide safe environments and effective supports that focus on the well-being of older people with increased care needs both in the community and in long-term residential care. The Government has delivered unprecedented levels of investment for the nursing home sector in recent years. This is a sector which is highly fragmented - many have spoken about this tonight - with 80% of nursing home care provided by private providers, including 4% voluntary providers. Within the sector, 15 companies control approximately 60% of all private beds under fair deal. The rest of the private sector is made up of smaller, in some cases, family-run, nursing homes the length and breadth of the country and embedded in our communities. Smaller and voluntary nursing homes may not have access to the same economies of scale as larger homes or groups. Residents in public HSE community hospital and community nursing units represent approximately 20% of fair deal scheme participants and there were 4,500 residents last year.

As referenced earlier by the Minister, we have provided an additional €75 million for PPE and oxygen to private nursing homes since 2021. This still continues and is a significant saving for private nursing homes. We have provided €150 million in payments through the Covid-19 temporary assistance payment scheme, €10 million through the temporary inflationary payment scheme and over €40 million for the nursing home support scheme this year. I fought hard to get that extra money in the budget with the support of the Minister. I checked the Sinn Féin health budget for 2023. It contains nothing for nursing homes or the NTPF. I am asking whether this was an oversight because there was nothing in it for nursing homes - not one cent.

In addition, more than €5 million has been provided from January 2022 to March 2023 alone to private nursing homes to support residents with particularly complex care needs. These are classed as top-up payments. I was delighted to be able to extend the temporary inflationary payment scheme on two occasions and up to the end of June 2023. Each nursing home could claim up to €5,250 per nursing home per month and the average amount per claim is €2,800 per nursing home per month. They could claim €5,250 but the claims are coming in at €2,800.

Investment in the nursing home sector has been a substantial priority for me and the Government but we know it is not just about investment and that meaningful reform is vital for the future of our long-term residential care sector. Both the Minister and I are committed to greater public provision of long-term residential care. A central component of reform is the implementation of the interRAI system. InterRAI will provide a wealth of data on dependency and will enable a care banding approach to funding. The focus is currently on piloting and embedding in home care with phase 2 involving a roll-out to residential care. InterRAI will facilitate effective, efficient, fair and transparent care needs assessment and planning and appropriate service delivery.

A review of the pricing system for long-term residential care facilities was carried out under the oversight of a steering group with representation from various Departments and agencies. The group made four recommendations and implementation is under way. I also acknowledge that a framework for safe nurse staffing and skill mix is under development for long-term residential care for older persons. The core objective of the framework is to better align staffing levels and skill mix with dependency levels in a facility. The nursing home sector has raised many concerns recently relating to cost pressures. There has been much media commentary on this matter. Some context with respect to the closures is important.

Data show that overall, 2022 saw a net addition of 112 registered beds to total national capacity of private beds registered with HIQA. The stock of private nursing home beds has increased by 185 registered beds to date in 2023. The number of private nursing home beds is increasing, as was borne out by the report. It is essential that when nursing homes are intending to close or to cease participating in the nursing home support scheme, residents and their families are consulted with and given appropriate notice in order that new homes can be found and residents can move in a safe, planned way. There is a legal requirement that providers must give at least six months’ notice to HIQA if they intend to close. This provides residents, families and public health authorities with appropriate time to respond effectively.

We know that so far this year, more than 120 private nursing homes have negotiated and signed new deeds of agreement with the NTPF. As these new contracts have seen an average baseline increase in price per bed of between 6% and 7%, the process is working for most nursing homes. Reform of the negotiation process now allows for 12-month contracts to be signed where requested. This allows nursing homes to renegotiate with greater regularity during an inflationary period.

There is no other mechanism for funding from the public purse for nursing home residents outside the nursing home support scheme. Other options to support nursing homes are also being explored such as help with the often costly nature of compliance for nursing homes under necessary HIQA regulations.

I now wish to speak about the commission on care. Acknowledging the disproportionately negative impact of the Covid-19 pandemic on older people, the programme for Government commits to the establishment of a commission on care that will "assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens". An initial scoping exercise for the commission on care has been undertaken. It is envisaged that the commission will support a whole-of-government and whole-of-society approach to examining existing policies and strategies that support positive ageing. It will effectively address the gaps that currently exist in the policy landscape. The commission will be established in autumn of this year.

Before I conclude, I wish to recognise the outstanding work of staff members across all of our long-term residential facilities and thank them for it. Our staff deserve to be paid well by their employers. For clarity, the motion calls on the Government to deliver and fund a collective pay agreement for workers in the nursing home and home care sectors. The Government cannot deliver collective agreements in the private sector. Collective agreements are a voluntary matter for employees and their employers or their representatives such as unions or both. The autonomy of those parties is to be respected. Work is ongoing by Government to introduce a new living wage set at 60% of hourly median wages in line with the recommendations of the Low Pay Commission to be introduced over a four-year period and be in place by 2026, at which point it will replace the national minimum wage.

In relation to transitional care funding, there is an approximate €32 million budget in place. Funding is granted to people in acute hospitals who have been medically approved as requiring long-term care and are in the process of an nursing home support scheme application. Last year, 9,500 transitional care funding applications were approved. This year, there have been 5,500 approvals up to June.

In addition, as of June 2023, there are 722 contracted beds currently on-stream between the HSE and private and voluntary nursing homes. Of these, 542 of these are nationally managed and 180 are locally managed in nursing homes across the country with a focus on providing short-stay residential beds with additional therapy and support services.

The Government is committed to supporting healthy and positive ageing, as well as ensuring that older people can continue to live independently in their homes and communities for as long as possible. This is the work this Government is currently engaged in and this is the work I will continue.

See this speech in context