Wednesday, 6 November 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Mental Health Services Provision
The Minister of State may have heard on the radio this morning the really shocking news that the St. Joseph's dementia care facility in Shankill has sent letters to the families of those people with dementia in the facility stating the belief that it may have to close very soon, possibly by the end of the year. This is the biggest and, arguably, the best dementia care facility in the country but it may have to close because of a deficit in funding. This is shocking news for people. Everybody in my area knows somebody with a family member in the facility. A member of my extended family suffered from dementia and she spent her final years there. The staff were wonderful and the care was really amazing.
One of the features of St. Joseph's is that it caters for high-dependency dementia sufferers. It was indicated to me by families of people using the service earlier in the summer that there was a problem. I tabled a parliamentary question at the time expressing concern about the funding deficit and the implications it could have for St. Joseph's but I was informed, in a fairly cold response, that the HSE was discharging its funding responsibilities under the fair deal scheme, which is more properly known as the nursing home support scheme. The problem is that this does not provide sufficient funds for high-dependency sufferers. The extra cost of providing care for high-dependency sufferers of dementia has been covered by St. Joseph's, leading to a deficit of €7 million building up to 2012. St. Joseph's has managed to cover the latter up to now. It is facing an ongoing deficit for this year of €1.2 million and it simply cannot cover it any more. This deficit exists because the National Treatment Purchase Fund, NTPF, the HSE and, ultimately, the Government will not provide the additional necessary funds for high-dependency dementia sufferers.
Ms Emma Belmaine, the chief executive of the facility, put it very well when she explained the cruel injustice of this for families and dementia sufferers. It is difficult enough for family members to deal with high-dependency dementia sufferers without them being treated in this way. She states:
Decision makers and funders need to understand that people living with a diagnosis of dementia cannot be discriminated against and are entitled to the same spectrum of care as those with a different terminal illness. Funding for dementia care also needs to be increased significantly and allocated fairly, not based on numbers in beds but on the needs of people. It should not matter whether the person is receiving that specialist dementia care in a HSE facility, a private nursing home or an independent not-for-profit facility such as St. Joseph's.
I ask the Government, as a matter of urgency, to cover the deficit and ensure the biggest and best care facility for dementia sufferers in this country does not close, causing great hardship for dementia sufferers and their families.
I thank the Deputy for raising this matter, which I am taking on behalf of the Minister of State, Deputy Jim Daly.
St. Joseph's in Shankill is a part of the St. John of God Hospitaller Services Group. It provides both residential care and day care for service users, all of whom have a diagnosis of dementia. Many of the 60 residential places are funded through the nursing homes support scheme. Separately, the HSE contracts for approximately 25 day care places per day at St. Joseph's.
The nursing homes support scheme, commonly referred to as the fair deal scheme, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. The nursing homes support scheme is expected to support 23,042 people at any one time in 2019. The scheme's budget for 2019 saw an increase of €24.3 million over 2018, making a total budget of €985.8 million for 2019. In 2020, the scheme will see a further investment in its budget of €45 million, bringing the total annual budget for the scheme to €1.03 billion.
This substantial investment will provide ongoing long-term residential care over the course of 2020, ensuring that the scheme can continue to deliver affordable and accessible nursing home care for our citizens with long-term care needs. The NTPF has been designated by the Minister for Health pursuant to section 40 of the Nursing Homes Support Scheme Act 2009 as a body authorised to negotiate with proprietors of non-HSE registered nursing homes to reach agreement on the maximum price that can be charged for the provision of long-term residential care services to nursing homes support scheme residents.
The NTPF has statutory independence in the performance of its function and negotiates with nursing homes on an individual basis. The Minister for Health does not have any role in this regard. The NTPF has clear and established processes for agreeing prices and has successfully negotiated terms with over 430 private and voluntary nursing homes participating in the scheme. The NTPF's processes are available to all nursing homes and since the end of 2017 there has been a net increase in the number of nursing homes operating in Ireland, with an increase of almost 1,300, or 5.7%, in the number of beds in the nursing homes with which the NTPF has agreed terms. In its statutory role to negotiate maximum prices charged for the provision of long-term residential care services to nursing homes support scheme residents, the NTPF established processes are the appropriate mechanism for engagement. The established processes include provision for an NTPF review mechanism where agreement is not initially reached on the price.
The HSE has been involved in extensive engagement with the St. John of God Hospitaller Services Group about the day care service at St. Joseph's and this engagement is ongoing. I acknowledge the role of private and voluntary providers in residential care provision. I encourage the St. John of God group to continue the engagement with the HSE on day care services. I also encourage the continued engagement with the NTPF processes with regard to the prices for the residential care services.
My office has been inundated in recent days by frightened people who have family members suffering with dementia in Saint Joseph's Shankill because of the possibility that this amazing facility will go. That would cause extreme hardship for dementia sufferers, their families and the wonderful staff and 100 volunteers who assist in this dementia care centre. For example, Frank wrote to me. He said his father died aged 48 years. Then his mother died two years ago in 2017. She was 92. He has been taking care of his stepfather, aged 87, who has had dementia since his mother's death. He works full-time and depends heavily on the service and help of the wonderful people in the day care facility at Saint Joseph's. He said without the service he does not know what he will do. He said the letter he received regarding the consequences should the facility close frightened him. I have received a range of other similar correspondence. Frank and the others who have written to me want to know that the Government is not going to let this facility close for the want of €1.2 million.
Will the Minister of State to acknowledge the point I made earlier? It was the same point Ms Emma Balmaine made, which is that the funding provided under the NTPF does not recognise the difference between low-dependency and high-dependency dementia sufferers. Every other part of our health service recognises that. No one suggests that regardless of how bad a person's cancer is or what level it is at, that person should get the same treatment regardless. The treatment is tailored to the need but when it comes to dementia sufferers the Government has decided a given amount is as much money as a dementia sufferer is getting and no more, regardless of his or her need. That is cruel and inhumane. By the way, the day care rate given by the HSE to Saint Joseph's Shankill has not increased by a cent since 2008 even though all the costs have gone up dramatically since then. I appeal to the Minister of State to get the Government to intervene to ensure this facility does not close because many people, staff and families will suffer if it does.
I wish to add my request to this. I wrote to the Minister in June about this. This is the most important and largest dementia care centre of its kind anywhere in the country. Those involved are leading the way. They have revolutionised dementia care in this country. They have been raising the issue for a long time. The centre is a high-care facility and it is getting approximately three quarters of the funding it needs. What is being sought is not much extra.
The letter the chief executive sent out explained that the centre will have to close the doors in approximately seven weeks. Approximately half the staff and patients there come from my constituency of Wicklow. The anguish and fear felt in Wicklow today over this is unprecedented.
Will the Government, as a matter of urgency, agree to short-term funding? We are talking about a small amount. It could ensure funding was in place for a six-month reprieve. That could give time for a proper renegotiation. We have to back these dementia facilities.
Of course, I will bring the concerns of the Deputies back to the Minister of State with responsibility for this area, Deputy Jim Daly, in respect of the important points raised in the debate. I fully acknowledge the important role played by the voluntary and private providers in the provision of services such as residential care and day care for older people, including those with dementia.
I assure the House that appropriate mechanisms exist for service providers such as Saint Joseph's Shankill to engage with the relevant agencies. The Deputies can tell those people who have major concerns or who are worried that, in respect of day care services, there has been intensive engagement between the HSE and Saint Joseph's Shankill this year. The HSE has committed to continuing this engagement with a view to further assisting the facility where possible.
The majority of residents are supported through the nursing home support scheme, under which residents contribute to the cost of the care according to their means while the State pays the balance of the costs. The NTPF has statutory responsibility for negotiating with individual private and voluntary nursing homes to reach agreement in respect of the maximum price that will be charged for the provision of residential care services to nursing home support scheme residents. The fund has well established processes with which all providers must engage. In the event that agreement cannot be reached through the engagement process with the fund, there is a process whereby the nursing home may seek a review by the NTPF chief executive officer. I understand that the initial engagement and negotiation process is active. Given the NTPF has statutory independence in the performance of its functions, it would not be appropriate for me to comment any further other than to reiterate my encouragement to Saint Joseph's Shankill to engage fully with the established processes.
I do not intend to, and will not, disrupt the order of the Dáil. We had a long discussion yesterday and, as you know, proceedings are ongoing about that. There will be more discussion about the issue of money messages. However, I want to get some clarity on precisely what happened to the arrangements for today. The communications that we got leave very big questions in my mind as to exactly how the arrangements for today unfolded or were revised. In the first instance, notwithstanding the issue of the motion and your ruling on the motion, a Cheann Comhairle, there was a slot for Solidarity-People Before Profit due to start now. That was still in the arrangements for today this morning when the business schedule was sent out. At some point later in the day, that slot disappeared. How did the decision happen? How did the slot disappear?
I have one last question. Given that we only received the correspondence at 9 p.m. on Monday, was it your expectation that we could then in that short period submit another motion for the slot, notwithstanding debate about the motion? I just want clarity about how all that unfolded.
It was my understanding, insofar as my understanding is of any benefit in these circumstances, that an alternative motion was suggested to your group, which would have allowed you to debate the generality of issues and, indeed, some of the specific aspects of the issues that you would have been debating had your motion been tabled, but you chose not to avail of that so we have no choice. We have no valid business from you. We had a vote on the Order of Business yesterday and we must proceed in accordance with that vote. We further had a discussion, as you are aware, at the Dáil reform committee where all of the members, save your own Solidarity representative, were of the view that we were proceeding in a correct and appropriate manner.
I wish to clarify one point. The vote that we took yesterday still included a slot for Solidarity-People Before Profit, did it not? That slot remained in the arrangements for today this morning.
We voted yesterday on the arrangements. The arrangements were agreed. There was subsequently no business submitted by yourselves that could go on the agenda and, therefore, we are where we are now.