Michael Ring (Mayo, Fine Gael)
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I thank the Ceann Comhairle for selecting my matter tonight. I thank the Minister of State, Deputy Butler, who at least has the manners to come in. I thank her for that. I am raising this very important issue of St. Brendan's nursing home in Mulranny. It is a tremendous facility with a wonderful reputation, opened in 1998. It is a rural based nursing home that provides many people with opportunities to remain and live in their own village. It is a not-for-profit nursing home and a registered charity but it is classified as private and is non-HSE.

Unfortunately due to rising costs, this nursing home is finding it increasingly difficult to survive. St. Brendan's nursing home urgently requires financial support from the Government. It is vital that we support community-based nursing homes. They provide tremendous service. With an aging population it is very important that beds are maintained and not closed down. St. Brendan's nursing home, along with other private, non-profit nursing homes carry out the same work as the HSE-run units with the same number of residents. The HSE units get 60% more funding than St. Brendan's nursing home and other private non-profit nursing homes. There needs to be equality and fairness in the system. We cannot let St. Brendan's nursing home close. It has been open for many years and there are many local patients depending on it. There is one patient there for 20 years. What is going to happen if that nursing home closes down? What is going to happen to that individual and other individuals who are in nursing homes in their own areas?

I might have disagreed with Dr. Jerry Cowley on many political issues but I compliment him on his role of chairman of this nursing home, dealing with all the rules and regulations for HIQA, with the beds that have been reduced, and having gone through Covid. The other big problem they have is something the Minister of State will have to deal with in respect of the HSE. Dr. Cowley spends €2,500 to go out to India and other world countries to bring in nurses. When their contracts are up, the next thing is that the HSE targets them and takes that staff away from him. The HSE can pay more, of course, because they pay out of taxpayers' money.

This nursing home is registered as a charity. I am asking the Minister of State two things tonight. St. Brendan's is getting approximately €1,000 per bed. That needs to be increased to about €1,600 to €1,700. The second and most important thing is that it is a charity. It should not be classed as a private nursing home. It should be getting the same funding as St. Fionnan's nursing home down the road in Achill which does the same job. It is another wonderful nursing home but it will be getting €1,600 to €1,800 and Dr. Jerry Cowley's nursing home is getting €1,000. It is very unfair. I am asking the Minister of State to talk to her officials and see if there is anything she can do. This nursing home is in a crisis. We have already lost 31 nursing homes since 2020 and we do not want to lose this.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this very important issue. He spoke to me about it earlier and when I went back to my office I looked up the facility he mentioned, St. Brendan's in Mulranny. It appears to be a fantastic facility for older people to age in their community.

I am keenly aware of the challenges that have been faced by the nursing home sector over the last three years. These have been exacerbated since last year by inflationary cost increases. I am delighted the Deputy raised the situation relating to voluntary nursing homes. I think he is the first person who has done so. Some 81% of nursing homes in Ireland are privately owned, about 3.5% are voluntary and 16% are in the care of the HSE and the State. The voluntary not-for-profit sector very rarely gets an outing on the floor of the Dáil, so I thank the Deputy for referring to it.

As the Deputy will be aware, budget 2023 saw an additional €180 million of funding for services for older people for winter 2022 and into 2023, building on unprecedented increases in recent years. This includes more than €40 million in additional funding for the nursing homes support scheme, NHSS, that we all know as the fair deal, which will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated. The Department of Health has regular interaction with the National Treatment Purchase Fund, NTPF. I met the NTPF again recently to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.

Other options to support nursing homes are also being explored. Those who had a scheduled renegotiation of their deed of agreement with the NTPF this year - 60% of nursing homes have renegotiated successfully - have seen a significant uplift of between 6% and 7% on their contracts. That increase will come out of the €40 million provided. In addition, homes that renegotiated their deed this year now have an opportunity to renegotiate every 12 months. Previously, it was every two or three years. We hope this will deal with the inflation issue.

The Deputy will be aware that we are in the budgetary cycle at the moment. I have had several meetings with my team in the Department and with the HSE. I will look positively at securing more funding for the nursing homes sector. I am acutely aware of the challenges small family, community and voluntary nursing homes face. They do not have the same economies of scale as larger nursing homes. We are speaking about 33 community beds in a rural area. While we have lost a lot of nursing homes, we have seen a net increase in beds, although they may not be in the areas where we need them. I take on board all the points the Deputy raised.

I acknowledge that there are variations in the cost of care across public centres and private and not-for-profit nursing homes, with public nursing homes or community nursing units, CNUs, generally having a higher cost of care. The HSE will always step in where a resident's needs are sufficiently complex that he or she cannot be cared for elsewhere in the community. The HSE needs to be equipped to deliver that kind of complex care. I recognise that private and not-for-profit nursing homes also deliver complex levels of care to residents in many cases.

The cost of care in public nursing homes is calculated annually by the HSE and implemented as part of the funding process for public units under the Nursing Homes Support Scheme Act 2009. A number of factors contribute to these higher costs including the statutory leave entitlements available to staff at public nursing homes, as well as the rate of pay within consolidated pay scales, and reductions in the number of long-stay public beds to comply with health and safety, fire regulations and HIQA compliance. Public nursing homes generally have higher nurse and other staffing ratios in place than private nursing homes.

Michael Ring (Mayo, Fine Gael)
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Is there anything the Minister of State can do in the short term to support this valuable asset we have in the Mulranny area? As I outlined, it is there not to make a profit but to serve the community. Dr. Cowley has a tremendous team of staff. Perhaps the Minister of State could take a trip some time to see the way the service operates. It provides meals on wheels and housing. It is under extreme pressure. HIQA has to come in and the home has to obey the same rules. Whenever HIQA visits it costs the nursing home. The number of beds has been reduced, costs are going up and it faces a crisis. Perhaps some of the Minister of State's officials will make contact with Dr. Cowley to see if there is anything they can do in the short term. I hope this can be resolved in the budget because these homes should be treated the same as public nursing homes.

Mary Butler (Waterford, Fianna Fail)
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One of the things I am hoping to get over the line in the budget is the provision of options to support nursing homes given the often costly nature of compliance with HIQA regulations. I fully support HIQA in what it does. At the same time, when HIQA goes into a nursing home there may be issues relating to infection prevention and control, health and safety, fire safety or ligature risks for older people. Addressing those can be very costly for nursing homes. I am looking at that area to see what we can do to support nursing homes in that regard.

As I outlined, an extra €41 million was provided. Approximately 60% of nursing homes have renegotiated their deed this year. They have seen an increase of up to 7% in their contracts, which has made a significant difference. I want to do more next year. There are nursing homes which were not in a position to renegotiate this year because they had renegotiated last year and are technically excluded from the additional funding. We are looking at that as well.

I am very conscious of all the matters Deputy Ring raised and I thank him for raising them. The voluntary not-for-profit sector does a very good job. I am looking at all options. I will take on board what the Deputy said. Mayo is one of the counties I have not been to but would love to visit.