Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"welcomes: — the extensive commitments by the Government to address long standing challenges in the Early Learning and Care (ELC) and School Age Childcare (SAC) sectors;

— the 72 per cent increase in State funding since the Programme for Government: Our Shared Future was published, and the achievement of the First 5: A Whole-of-Government Strategy for Babies, Young Children and their Families 2019-2028 investment target set in 2018, five years ahead of schedule, with over €1.1 billion in State funding allocated for the sector this year; further welcomes the significant prioritisation by the Government of measures designed to: — substantially reduce out-of-pocket costs of ELC and SAC for families;

— increase the pay and improve the conditions of early years educators and school-age childcare practitioners;

— place ELC and SAC providers on a solid, sustainable footing; and

— recognise and bolster the vital public good contributed by the sector; acknowledges and welcomes the major achievements of the new funding model Together for Better, which brings together the National Childcare Scheme (NCS), the Early Childhood Care and Education (ECCE) programme, including the Access and Inclusion Model (AIM), Equal Start and the Core Funding Scheme, in particular: — the roll-out and on-going enhancements to the NCS, which is providing subsidies, both targeted and universal, to record numbers of children this year, with €369 million secured in Budget 2024 to substantially reduce out-of-pocket costs of ELC and SAC to families, currently by 25 per cent on average and by 50 per cent on average from September;

— the roll-out of the ECCE programme, which enjoys uptake rates in excess of 95 per cent and has removed barriers to accessing pre-school education, with data from Growing Up in Ireland showing that more than 60 per cent of low income families would not have been able to send their child to pre-school without this programme, as well as work underway to enhance this programme, with an evaluation as a precursor to putting the ECCE programme on a statutory footing now complete;

— the roll-out of the award-winning AIM, that is supporting more than 7,000 children with a disability each year to access the ECCE programme, with preparations now being made to enhance and expand AIM beyond the ECCE programme, commencing from September 2024, where ECCE children will benefit from AIM support outside the ECCE programme hours, both in term and out;

— the introduction of Equal Start this September, a new funding model and set of universal and targeted measures to support access to, and participation in, ELC and SAC for children and their families who experience disadvantage;

— the Core Funding Scheme, with an allocation towards operating costs (pay and non-pay) of ELC and SAC providers that far exceeds the rate of inflation (i.e. €259 million in its first year and €287 million in year 2) to support the historic Employment Regulation Orders for the Early Years Services Sector, which came into effect in September 2022, providing minimum hourly rates of pay for early years educators and school-age childcare practitioners, increasing the wages of an estimated 73 per cent of those working in the sector, with proposals for a 5 per cent increase in these minimum hourly rates of pay and a proposal for the removal of the 3 year experience rule for graduate minimum pay rates recently submitted to the Labour Court by the Joint Labour Committee;

— extended support for graduate-led provision outside the ECCE programme, with almost 3,000 services now receiving graduate premiums;

— the introduction of a new fee management system in a sustainable and considered manner, which initially means no increase in fees since September 2021, which, in tandem with developments to the NCS, is delivering enormous benefits to families;

— the introduction of a requirement on services to offer the NCS to all eligible families, including sponsored arrangements, which has led to a 20 per cent increase in the number of services offering the NCS, a 52 per cent increase in the number of sponsored children and a 100 per cent increase in the numbers of children benefitting in the last two years alone, thus substantially widening access to this State support; and

— the allocation of increased funding for 99 per cent of services in year 1 of the Scheme, with no services experiencing a decrease in funding, and the allocation of substantial increases in year 2 for all services so that with ECCE capitation and Core Funding combined, services receive a minimum of €79.20 per child per week in capitation under the ECCE programme and a maximum of €95.85 per child per week with additional funding for graduate lead educators and graduate managers in the case of sessional services, and in addition to this, small and sessional services benefit from targeted measures introduced in year 2 of Core Funding at a cost of €7.2 million, specifically a flat rate top up of €4,075 for sessional-only services and a minimum base rate allocation of €8,150, and these measures saw the average allocation under Core Funding for sessional-only service increase by 30 per cent this year; also welcomes: — that the allocation for Year 3 of the Core Funding Scheme (from September 2024-August 2025) will increase by €44 million or 15 per cent, to €331 million, and this will support the delivery of a range of enhancements in Year 3 of the scheme to support improved affordability and accessibility for families, improved pay and conditions for the workforce and continued improvements, stability and sustainability for providers;

— the importance of the provision of validated financial returns as part of Core Funding given the scale of State investment in ELC and SAC and the importance that these data, which will underpin funding policy by Government, are comparable across all services in terms of income and expenditure components and in terms of reporting periods;

— the outcome of the intensive engagement between the Department of Children, Equality, Disability, Integration and Youth with members and nominees of the Early Learning and Childcare Stakeholder Forum, to streamline and simplify financial reporting requirements this year and next; and

— the targeted support offered to services to fulfil their financial reporting obligations under Core Funding, in addition to €32.3 million allocated under Core Funding this year for administration; further acknowledges and welcomes the latest data from a range of sources that shows capacity in the ELC and SAC sector is growing, including: — the latest Annual Early Years Sector Profile Survey, which shows that, between 2021-2022 and 2022-2023, the estimated number of enrolments in services rose by 8 per cent from 197,210 to 213,154;

— the Core Funding application data which shows that between Year 1 (from September 2023-August 2024) and Year 2 (from September 2024-August 2025) of the scheme, annual place hours increased by 7.4 per cent;

— the latest data from Tusla on service closures and new service registrations, which shows a net increase of 129 in the overall number of services in 2023, and a five-year low in the number of net ELC service closures, with ELC service closures falling by 18 per cent since the introduction of Core Funding; and

— the wider reform agenda underway in the area of ELC and SAC, through implementation of a range of other policies and programmes, including:

— the Building Blocks Capital Programme for Early Learning and Childcare, under the National Development Plan, that is designed to meet current and long-term ELC and SAC infrastructure needs;

— the work underway to implement the National Action Plan for Childminding (2021-2028), with a commitment to opening the National Childcare Scheme to childminders this autumn;

— the work underway to implement Nurturing Skills, the Workforce Plan for the ELC and SAC Sector (2021-2028), with commitments to develop career pathways, promote careers in the sector and support staff recruitment, complementing recent achievements, and future plans to improve pay and conditions of employment in the sector; and

— the work underway to develop an action plan for administrative and regulatory simplification for the ELC and SAC sector, informed by an independent third-party review of end-to-end processes linked to publicly funded ELC and SAC schemes/programmes and a series of regional stakeholder consultation events; notes: — the recent Organisation for Economic Co-operation and Development (OECD) data that shows Ireland's performance in supporting families, and particularly lone parent families, with the cost of early learning and childcare is markedly improving, even before the impact of recent enhancements to the NCS or the fee freeze is taken into account, specifically, OECD data that shows Ireland having the highest decrease in early learning and childcare costs to families across the European Union (EU) over the period 2019-2021, and that shows net childcare costs as a share of the household's net income for lone parents on low income in 2021 falling below the EU average for the first time;

— the recent report from the National Competitiveness and Productivity Council entitled 'Ireland's Competitiveness Challenge 2023', that welcomes the ongoing work by the Department of Children, Equality, Disability, Integration and Youth in this policy area and notes progress made likely to be 'a contributing factor behind the increase in female participation and our better performance in this area than many EU countries';

— the 2023 Country Report for Ireland from the European Commission which rated Ireland's progress on the County Specific Recommendation to 'increase access to affordable and quality childcare' as 'substantial'; and

— the recent OECD Country Policy Review of Early Childhood Education and Care in Ireland concluded that 'Ireland is currently pursuing a strong policy agenda for Early Childhood Education and Care, with the adoption of a long-term whole-of-government strategy for babies, young children and their families covering the period 2019 to 2028' and acknowledged that 'the country has committed itself to improving access, affordability and quality of ECEC provision'; and furthermore, with regard to Nursing Homes, recognises and acknowledges that: — increases in year-on-year funding for the Nursing Homes Support Scheme (NHSS or Fair Deal) will reach €1.5 billion this year;

— Budget 2023 saw over €40 million in additional funding for the NHSS, and an additional €45.6 million has been allocated to support nursing homes in Budget 2024, including a new €10 million fund to support private and voluntary nursing homes with Health Information and Quality Authority compliance;

— 2022 saw a net addition of 112 registered beds to total national capacity of private beds, 2023 saw a net addition of 490 beds to total national capacity of private beds and 2024 has seen an increase of 117 beds to date;

— a significant change the National Treatment Purchase Fund have made to their negotiation process is to offer nursing home providers contracts of a shorter duration, to ensure that rate increases stay aligned with cost pressure increases that may occur;

— the National Treatment Purchase Fund renegotiated over 300 Deeds of Agreement with nursing homes in 2023, which resulted in a 6-7 per cent average uplift, and there are approximately 400 scheduled renegotiations due in 2024, with the average uplift being 5 per cent to date, and small rural nursing homes are receiving larger uplifts on average;

— the Productivity and Savings Taskforce was established in January 2024, and the Minister for Health requested the Secretary General of the Department of Health and the CEO of the Health Service Executive (HSE) to co-chair a programme to drive savings and productivity improvements across the HSE, with a key action being to secure a reduction in the cost of care in HSE long term residential care facilities for older people, and the Taskforce will provide monthly updates to the Minister for Health;

— the Community Nursing Unit Capital Programme is successfully progressing, and as of January 2024, 48 projects have reached construction completion and construction is underway on several more facilities, and a total of €13.7 million has been made available to staff and operationalise new and replacement community beds in public Community Nursing Units (CNUs) and Community Hospitals throughout the country in 2024, and this funding will deliver 985 community beds this year (811 replacement and 174 new);

— the Government has funded a pilot for the Framework for Safe Nurse Staffing and Skill Mix in Nursing Homes Settings for Older Persons which is scheduled to conclude in 2024, and this initiative aims to develop an evidence-based framework that will determine staffing levels and skill-mix requirements in nursing homes, and which will take account of dependency levels of residents;

— over €3.2 million in State support has been provided for over 440 registered nurses in private nursing homes to obtain a Postgraduate Diploma in Gerontological Nursing, and this follows earlier similar funding provided to nurses in public and voluntary nursing homes;

— the HSE issued a directive in October 2023 to Chief Officers in every Community Health Organisation (CHO) to provide all nursing homes, both public, private and voluntary, with details on access pathways to aids and appliances within their CHO, and the CEO of the HSE has committed to ensuring that primary care services that are available to people living in their own homes will be equally available to people living in nursing homes, both public, private and voluntary, with the Department of Health collaborating on this initiative; and

— this year, a new community-based mobile X-ray service has been made available to residents in nursing homes and CNUs nationwide, and this is a free, community-based service available to all residents and follows a successful pilot.".

I welcome this opportunity to address the House on the issues raised by the Deputies tabling the motion. I will focus the content of my opening statement on the care of older people and the Minister, Deputy O’Gorman, will speak to early learning and childcare in the closing statement. We felt it was better to do it in this way because this comes under two different Departments.

As Minister of State with responsibility for mental health and older people, I deeply appreciate the care services provided to older people in the State by public, private and voluntary nursing homes. I take this opportunity to recognise the hard work of nursing home staff up and down the country and thank them for their commitment and for the care they deliver for older people every day.

The Government has delivered unprecedented levels of investment in our health service. Over the last four years, this Government has overseen an increase in the net core allocation for our health services from €17.9 billion to €22.5 billion. This increased State investment has included the nursing home sector. Funding to support people to access long-term residential care is provided through the nursing homes support scheme, also known as the fair deal scheme. Over €85 million in funding has been allocated over the past two budgets for additional nursing home supports, providing stabilisation to the nursing home sector. I did not have many issues with the motion apart from the call to “put in place an immediate "stabilisation fund" of €265 million”, and I could have worked with all of the rest of the motion with regard to what fell under my remit. In its prebudget submission last year, Nursing Homes Ireland looked for a stabilisation fund of €191 million. I am not sure where the figure of €265 million has arisen from, given it is an increase of €74 million in just over four months. I am not sure that any Department could sustain that type of increase. What I have put in place in the last two years is an additional €85 million and we have seen an uplift as a result.

The Government has provided substantial support to help stabilise the private and voluntary nursing home sector. This year, €1.5 billion, including client contributions, will support 27,000 people across the nursing home sector. That is €1.5 billion out of a budget of €22 billion for 27,000 people. We need to let that sink in. It is a substantial amount of money. Over €151 million of financial support was provided during Covid, the provision of free PPE and oxygen to nursing homes cost approximately €77 million and a €10 million temporary inflationary payment scheme was established. This investment is clear, tangible evidence of the commitment this Government has made to provide additional and concrete supports to the nursing home sector.

Budget 2023 saw over €40 million in additional funding for the nursing homes support scheme, which is providing for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated. In simple terms, a 50-bed nursing home would last year have received an additional €200,000, which is substantial money by any yardstick. An additional €45.6 million has been allocated to support nursing homes in budget 2024, including a new €10 million fund to support private and voluntary nursing homes with HIQA compliance.

The resident safety improvement scheme is designed to target and support structural improvements in nursing homes to assist with meeting HIQA compliance plans in respect of protection against infection and fire precautions. Each nursing home can claim up to €25,000 for eligible works. It was backdated to 1 January 2020 to take into account any work that was done during Covid. To date, 82 nursing homes have availed of €1.8 million.

The increased budget and financial supports that I have outlined are making an impact. Any nursing home that has had a scheduled renegotiation of their deed of agreement this year with the NTPF has seen a significant uplift. The NTPF renegotiated 257 deeds of agreement with nursing homes in 2023, which resulted in a 6% to 7% average uplift. Nursing homes can now renegotiate every year. There are 389 scheduled renegotiations due in 2024, with the average uplift being 5% to date. Small rural nursing homes are receiving larger uplifts on average.

Work is ongoing to expand care services to nursing home residents. I was disappointed that such services were not mentioned in the motion. This year, a new community-based mobile X-ray service has been made available to residents in nursing homes and CNUs nationwide. This is a free, community-based service available to all residents. Patients do not need a medical card to avail of the service provided in public community nursing units or private and voluntary nursing homes. As of March this year, over 10,000 examinations have been carried out across more than 350 nursing homes, which means an older person will not have to go to the emergency department after the X-ray is provided unless they have a broken bone.

Work is continuing on the expansion of primary care services to nursing home residents. The HSE issued a directive in October 2023 to chief officers in every CHO to provide all nursing homes, both public and private, with details on access pathways to aids and appliances within their CHO. The CEO of the HSE has committed to ensuring that primary care services that are available to people living in their own homes will be equally available to people living in nursing homes.

Another initiative that I have brought forward is to support staff upskilling. Over €3.2 million in State support has been provided this year for more than 440 registered nurses in private nursing homes to obtain a postgraduate diploma in gerontological nursing. This follows earlier similar funding provided to nurses in public and voluntary nursing homes. A further and welcome development and a key recommendation from the value for money review of nursing home care costs was the establishment of a safe staffing and skill mix framework for residential care. A baseline report was published in 2022 and an interim report on the progress of the pilot was published in 2023, with the final report due to be published later this year.

Over the same period, there has been growth in private bed capacity. As per the most recent HIQA report, 2022 saw a net addition of 112 registered beds, 2023 saw a net addition of 490 beds to the total national capacity of private beds and 2024 has seen an increase of 117 beds to date. This increase in capacity is welcome and will be augmented by the work on public community nursing units. The Government is investing in the provision of additional and replacement community beds. The community nursing unit capital programme is successfully progressing. As of January 2024, 48 projects have reached construction completion and construction is under way on several more facilities. I was honoured to open the new community nursing unit in Ballyshannon two weeks ago, where Deputy Harkin joined me. The unit was provided at a cost of €37 million. This fantastic facility will provide long-stay beds and short-stay beds supporting Sligo University Hospital and Letterkenny University Hospital, as well as rehab, respite, dementia and palliative care.

The Department of Health acknowledges there are variations in the cost of care across public centres, as well as across private nursing homes, with public nursing homes generally having a higher cost of care. The HSE will always step in when a resident’s needs are sufficiently complex that they are not able to be cared for elsewhere in the community. The HSE needs to be equipped to deliver this kind of complex care as the provider of last resort. At the same time, the HSE must offer value for money for the taxpayer. To this end, the productivity and savings task force was established in January 2024. The Minister for Health requested the Secretary General of the Department of Health and the CEO of the Health Service Executive to co-chair a programme to drive savings and productivity improvements across the HSE. A key action is to secure a reduction in the cost of care in HSE long-term residential care facilities for older people.

Safeguarding adults who may be at risk of abuse, harm and neglect by others in the context of their interactions with the health and social care sector, including in nursing homes, is a key objective for me. A new national policy on adult safeguarding in the health and social care sector is at an advanced stage of development and a public consultation on the Department’s policy proposals closed last month.

I thank HIQA for its continuous patient-centred work, ensuring standards for all residents across all nursing homes are met. The importance of unannounced inspections is a policy I completely support. I also recently launched a consultation on draft design guides for long-term residential care settings for older people, for any new builds or extensions. Feedback received will inform the final version of the design guide.

I also ensured the continued expansion, which is very important, of the patient advocacy service, a national service commissioned and funded by the Department of Health. This service provides a free and independent national service which helps people using healthcare to make a formal complaint regarding the care they have received. Previously, this was only available in the public sector but it has now been rolled out to all of the voluntary and private sectors.

To close, I want to touch on the commission on care that I have established with the Minister, Deputy Donnelly. It has met twice to date and is examining the provision of health and social care services. These are ambitious reforms that I have mentioned and they are about ensuring appropriate, high-quality, regulated and safe care is delivered to the population in the future and that the nursing home sector can operate in a sustainable manner.

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