Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We will now move back to the first Topical Issue matter, which was submitted by Deputy Flaherty.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I thank the Ceann Comhairle for his forbearance at the outset. I appreciate that we are here at an unusually late hour after a long day in a long week, but it behoves me to share my concerns with the Minister of State, Deputy Butler, about the funding of our nursing homes. Whether we agree with it or not, we are dependent on a network of privately owned nursing homes. My office - and probably the Minister of State's constituency office more than any other - is besieged with calls from families desperate to get loved ones into a nursing home, secure what is now almost elusive respite care or relocate a loved one closer to his or her family and community. Increasingly these calls are fraught. People are increasingly angry and consequently turn to their local representatives. Sometimes it is hard to tell these people what I am about to tell the Minister of State, which is the reality on the ground. Put simply, we have a funding deficit in our nursing homes. We have five excellent care providers in the immediate Longford area, all privately run and owned. We also have the State-run and fully funded St. Joseph's in Longford town.

I know the Minister of State is on record as stating State-run community nursing units provide more complex care for residents and that these receive more money as a consequence. There is no doubt that the level of care at the aforementioned St. Joseph's is exceptional. It has a unique place in the hearts of the people of Longford. The staff are first class. I have never come away from there unimpressed by the care, dedication of the staff and welfare and well-being of the patients. I see care and attention of the same level in the four privately-run nursing homes.

An increasing number of small, local and, in many cases, family-run facilities, typically with 40 to 50 beds, are now leaving in the market. I was especially disappointed to see a recent newspaper report blame their exit on a desire to provide emergency accommodation to Ukrainians instead. The newspaper narrative was that this was much more profitable. However, that is not the reality. It was deeply unfair to several families, many of whom have dedicated two and often three generations to the consummate care of elderly neighbours and friends. The reality is that the family-run facilities were creaking under the pressure of punitive and ever more challenging HIQA standards and rapidly increasingly costs.

I know one of the families who opted to leave the sector. Their decision was far from easy and arrived at only after months of agonising and many sleepless nights. Family and friends tell me of the all-consuming stress and anxiety that overwhelmed the family leading up to the final fateful decision. It was a heartbreaking decision for them. A few months later, free of the pressures, financial stresses and worries, it is as if a weight and terminal pressure has been lifted from them.

I know the Minister of State has worked tirelessly with her ministerial colleagues and recently signed off on additional visas for care staff to come into the nursing homes.

I am aware that the Minister of State, Deputy Butler, has worked tirelessly with her ministerial colleagues, and has recently signed off on additional visas for care staff to come into nursing homes. However, the reality is that these facilities are now facing an almost daily battle with the HSE for staff. It is often unsavoury and, in the early days of the battle when it was not yet clarified as to whether staff in private nursing homes would get the pandemic bonus, the HSE was bandying this as a carrot in the hope of attracting staff.

I greatly admire the work the Minister of State does and I know she is personally invested in the care and well-being of our older generation. I know how passionately the Minister of State, Deputy Butler, cares for them and how she is striving to look after the men and women who forged one of the most progressive, ambitious and capable nations in a modern Europe. We and their families need to be reassured that there is an unrivalled level of care available to these people. These are the people who taught us, served us in shops, nursed us, and advised us. When we needed them they were there and now they in turn need us more than ever.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Minister of State, Deputy Butler, for being here to deal with this matter.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Flaherty for raising this issue. Before I deal with the substantive issues raised, I wish to state categorically that when it comes to HIQA regulations I will never compromise. I will not apologise to anybody in the House for having regulations and standards in place. It is very important that we have oversight and that we have an organisation such as HIQA that can go into any long-term residential care facility to check that best practices and best supports are being provided to our older generations. As Deputy Flaherty has said, they built our country, and they served us in shops and the like. Just so there is absolutely no ambiguity, there will be no movement in relation to standards while I am the Minister of State.

The Government is keenly aware of the challenges that have been faced by the nursing home sector across the country over the last three years. These challenges have been exacerbated over recent months by the increases in energy costs and inflation costs due to volatile global conditions. It is a priority for me that we maintain nursing home provision in rural areas to ensure people can stay living close to their home communities when they need to enter residential care.

I have a budget to work within. My budget for 2022 was €1.4 billion for nursing home care. This is to support some 22,500 people to be able to afford to receive very good services in nursing homes and in community nursing units - public, private and voluntary. I must make sure this budget lasts from 1 January until 31 December every year. As a result, when somebody applies for the fair deal scheme to enter into a nursing home, I can ensure there is a four-week turnaround. Many Deputies who are here longer than me can remember a time when this was not the case. Only a few short years ago, when the budget ran out it took 12 weeks for somebody to access nursing home care. This is my first point.

The Government has provided substantial support to the private and voluntary nursing home sector over the pandemic, with more than €145 million in funding delivered through the temporary assistance payment scheme, TAPS, as well as other supports delivered directly through the HSE, including serial testing, the provision of personal protective equipment, PPE, and the deployment of expert response teams. The TAPS Covid-19 outbreak assistance has been extended to the end of this year. From 1 April 2020 to 31 October 2022, the provision of free PPE and oxygen continued at a cost of €70 million to private nursing homes and a cost of €2.5 million to voluntary nursing homes. This information is not really in the public domain and it needs to be acknowledged.

Further funding was secured in budget 2023 to fund increases in the nursing home support scheme, NHSS, budget. I have secured additional funding for the National Treatment Purchase Fund, NTPF, fair deal for 2023 to maintain services and manage inflationary increases. Just over €40 million has been secured for the NHSS, including pressures for next year. This will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.

I recently put in place a new scheme, the temporary inflation payments scheme. This €10 million scheme, which has recently been opened to applications, has been established to support private and voluntary nursing homes with increases in their energy costs. It covers 75% of the year-on-year cost increases in energy and heating. I have backdated it to 1 July 2022. Each nursing home can claim €31,500 up to the end of December. I expect to extend that scheme into January.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I thank the Minister of State, Deputy Butler. I would certainly like to think that the nursing home operators and providers acknowledge the supports they have received to date. I believe the nub of the issue is money. We must acknowledge that the numerous costs being absorbed by private nursing homes are not applicable to public facilities. These include, for example: capital costs; commercial rates; insurance; and education and training.

I agree that the fair deal scheme has been a lifeline for families. The Minister of State, Deputy Butler, must be credited for her work early in the lifetime of this Government in bringing to fruition the legislation providing for the three-year cap on assets, specifically for family farms and family businesses. At the heart of the fair deal scheme is the weekly payment from the HSE to public and private nursing homes, which is paid on a per patient rate. Five years ago, the HSE was paying the publicly run and funded St. Joseph's in Longford €1,912 per week while Laurel Lodge, a short distance down the road and one of the aforementioned five privately run nursing homes, was receiving just €930 per week. That is a difference of €982 per week. Five years on and the payments are increasing nominally but, alas, the gap between what is paid to the private and publicly run nursing homes has increased significantly. Now the public nursing home gets just over €2,000 per week while Laurel Lodge remains more than 100% off that rate at just over €1,000 per week.

Private nursing home operators are worried and genuinely concerned. Staff are stressed and anxious. Most worrying is the fallout from this, which is having consequences for the many families who are desperately trying to ensure the best possible care for their relatives in their twilight years. I cannot comprehend the differences in the payments being paid to the public and private nursing homes. I understand and expect that the HSE and the Minister of State's office will tell me that additional services are being provided in public nursing homes, but I am not convinced. I see no discernible difference in the level of care provided. As a matter of urgency we must review how we fund our private nursing homes.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy. On the funding of the private nursing homes, last year my budget was €1.4 billion. The private nursing homes received €1 billion of that €1.4 billion, supporting 18,000 people, whereas the HSE supports 4,500 people under fair deal. It must also be appreciated that residential HSE-run community nursing units and community hospitals are often staffed at a level that allows the delivery of more complex care where required. These facilities represent less than 20% of the fair deal scheme.

The Deputy said he has not seen the evidence. Today, for example, I was in Cherry Orchard Hospital. I just pick this as it was the most recent one I was in. It currently provides residential care for 113 residents, both male and female. I did see a difference in the supports being provided. Nursing care is available for intravenous drugs; IV fluids; sub-cutaneous fluids; tracheotomy care; and care for those requiring medication via syringe driver. Nursing staff on site include registered general nurses, many of whom have postgraduate qualifications, and a registered advanced nurse practitioner in older persons services with a specialist interest in behavioural therapy. There was also a consultant physician in care of the elderly available, medical officers, pharmacists, occupational therapy and physiotherapy. I am trying to say that we are not comparing like with like across all the nursing homes. They vary. The nursing home sector is very fragmented - 15 companies provide 10,700 nursing home beds in Ireland. I am very conscious of the small, voluntary, rural nursing homes that are family run and are in trouble. I will take this opportunity to assure the sector that I am taking the matter very seriously. I am engaging with my officials as a matter of urgency to appropriately address the challenges the sector faces. At the same time, all the nursing homes must manage their financial challenges. I must manage mine as well. I am acutely aware of the challenges at the moment.