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

I thank the Minister and Minister of State for being here today. I thank the Minister of State, Deputy Butler, for listening and giving me a considered response. The Minister just arrived - I will come back to his amendment. The Minister of State said that she could work with the content of my motion, broadly speaking, except for the stabilisation funding request. I want to explain where that came from. That funding would be to stabilise nursing homes in counties where fair deal payments are lowest. An issue I did not get to in my introduction was the difference in fair deal funding to different types of nursing home. The Minister of State is quite familiar with it. As I said, I relied on the ESRI report. It identified large differences in fair deal funding across public and voluntary or private nursing homes. It tells us that the average price for a fair deal-funded bed in public nursing homes is 55% higher than in voluntary or private nursing homes. It goes on to state that this puts many private, voluntary and not-for-profit providers under severe pressure. That is what the ESRI said in its 2024 report. That is what I am talking about. She is the Minister of State. She knows how to deal with this in a better way than me. I put forward proposals. If she can live with some of them, that is good. If she can come forward with others, I will be happy. I just want to see that this sector and, especially, smaller nursing homes, can survive.

I will give an example because sometimes an example illustrates very clearly. These are from the ESRI. The average private nursing home fair deal rate in Leitrim is €1,041 per patient, per week. The average per patient, per week in a private nursing home in Dublin is €1,302. If there is 40-bed nursing home, that is a difference of more than €500,000. Do not tell me those extra costs are in Dublin because they are not. On top of that, there is the third tier. There is the public nursing home bed. According to the ESRI, they are on average 55% to 60% more per patient. Going back to Leitrim, the Minister of State told me that the Government is giving an extra uplift and an extra payment of 5%, 6% or 7%. That is fine but the difference between payments in Leitrim and Dublin for private nursing homes works out at around €261 per patient, per week.

A top-of-the-range 7% increase is still only closing the gap to the tune of €72. I will not even talk about the differences when it comes to public nursing homes. The Minister of State knows the story. That is why we need some kind of stabilisation fund.

I am really concerned that some of the smaller nursing homes will close. The Minister of State and I know that if they close, they will not reopen. Other nursing homes may open, but they will not be in the same locations. They will be in larger towns and cities and older people will have to leave their communities, their doctors, pharmacists, families and their friends. That is a crucial issue, and the consolidation of nursing home ownership will bring about greater regional imbalance. It means that counties like Sligo, Leitrim and Donegal, rural counties that I represent and that have higher dependency ratios, will suffer the most.

I am pleased that the Minister of State could live with my motion to reform the fair deal pricing model in order that it will be based on resource allocation. As with Slaintecare, the money should follow the patient. However, it is not in place now and will not be in place for a while. Until it is, I ask that the Minister of State look at some kind of stabilisation fund to make sure that many the smaller nursing homes I am speaking about do not close and can hold on because they know it is planned to bring about that reform. In the meantime, they can keep going.

I read the amendment from the Minister, Deputy O'Gorman. I was a bit disappointed with his response from the perspective that he did not deal with the two main issues. He sort of did in the end in the form of the charter of accounts, which I will come back to, but he did not really deal with the issues I raised. Is he aware of a document produced today called United We Stand? It was published by the Federation of Early Childhood Providers with more than 300 letters from more than 500 submissions and asked that the Minister listen and consult with the sector. He was not here earlier but I appreciate that he is here now. One point I made is that I see childcare like a three-legged stool, and the Minister has made progress. He has made progress on fees. There needs to be more, but he has made progress. He has made progress on staff payments. Again, there is further to go, but he has made progress.

The third leg of the stool - the providers - is the leg that is broken for many of them. I have met them at meeting after meeting in the audiovisual room, outside the Dáil and all over my constituency, not just in recent months but over the past two years in particular. I wonder if the Minister was listening to "Liveline" this afternoon. He probably was not, but one parent after another spoke of not being able to access childcare. Part of the reason that is happening is that many small childcare providers are closing this summer or will do so next summer. The most recent meeting I attended was in County Sligo. Seven services were saying that they will either close this year or next. That is 10% of the total childcare provision. I said to the Minister of State earlier that the small village of Coolaney, which has a population of 1,000, has three childcare providers. Two of them will be closing their doors this summer. That is happening because some of these providers are stuck in a historical model of a pay freeze. I know why the Minister did that, but new entrants to the market - new childcare providers in new premises - many of them large groups and multinational groups, can charge higher fees and still access the core funding. I ask that the Minister look at this and try to end that historical fee freeze and in some way achieve a balance between the two. If he could do that, it would go a long way. I also asked for an increase in ECCE payments to €100. I am not sure he is prepared to go that far but I ask him to go as far as he can.

I move to my final point. I do not know how to say this. If there is one word that comes to mind every time I think of meetings I have had with childcare providers, it is that they want a bit of respect. They want somebody to listen to what they are saying. I am talking in particular about the issue of two sets of accounts. I know the latter probably suits somebody in Pobal or the Department. However, a small childcare provider with between ten and 15 children has to do two sets of accounts. There is one running from December to December for Revenue and one running from September to August for Pobal, and a chartered accountant has to oversee those accounts. Apart from the work involved, there is also a massive cost. There are different timelines, two different sets of accounts and extra work. I do not know what the Minister can do or how far down the road he is on this. I earnestly ask him to do anything he can to cut back on this unbelievable bureaucracy and red tape that is being forced on the shoulders of childcare providers.

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