Marian Harkin (Sligo-Leitrim, Independent)
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I move:

That Dáil Éireann: notes that:

- quality, accessible and affordable childcare and nursing home services are an indispensable part of the fabric of any well-functioning society, and these services support individuals and families at different stages of their lives, but most especially at both ends of life when they are in greater need of care;

- services like childcare and nursing home care are mandated by the State to operate with a certain ratio of staff to each individual accessing the service, and this has led to a situation where there is a steadily increasing cost base while incomes are not keeping pace;

- the trend towards the closure of smaller local childcare services and smaller nursing homes, which are often family run, leads to significant difficulties for individuals and families in accessing essential services locally, and also leads to regional inequalities in the supply of these services;

further notes that, in the case of the childcare sector:

- Tusla (the Child and Family Agency) data shows that 106 Early Learning and Care services closed between January and August 2021, a total of 113 closed during the same period in 2022, and 86 closed during the same period in 2023, representing an average of just over 100 closures per year and the vast majority of these closures were in small- and medium-sized services;

- the introduction of core funding combined with the high level of inflation and the freezing of fees has resulted in many service providers coming under severe financial strain;

- this situation has been exacerbated by the fact that new entrants to the market, often larger providers, do not have to comply with any cap on fees and can still avail of the same level of core funding as established providers, which leads to an anti-competitive business environment;

- the introduction of the Core Funding Chart of Accounts (CFCA) financial reporting requirement has placed a heavy and unnecessary administrative burden on managers and providers, and it has also placed a severe financial burden particularly on smaller providers whose profit margins are unable to sustain the significant extra costs involved;

also notes that, in the case of nursing homes:

- if the Health Service Executive (HSE) forecast for capacity requirements for 2031 is to be met, a further 11,000 beds are required in the sector, and yet, despite these forecast capacity requirements the spend on the Fair Deal Scheme as a proportion of overall health expenditure has steadily declined over the last decade;

- the Economic and Social Research Institute (ESRI) report entitled "Long-term Residential Care in Ireland: Developments since the onset of the Covid-19 Pandemic", published in January 2024, confirms that independently owned and operated nursing homes, many of which were family run businesses, and which until recently dominated the sector, now only supply 35 per cent of beds;

- there has been a marked shift towards a consolidation of nursing homes under larger operator groups, many of whom are recent entrants to the Irish market and some of whom are financed by international private equity;

- the same ESRI report identifies large differences in the Fair Deal Scheme funding across public and voluntary or private nursing homes, with the average price for a Fair Deal funded bed in public nursing homes being 55 per cent higher than in voluntary or private nursing homes, and this puts many private, voluntary and not-for-profit providers under severe financial pressure; and

- the ESRI identifies regional inequalities in nursing home supply and according to their research, which is based upon future planned development, these inequalities are likely to be exacerbated in the near term;

calls on the Government to put in place specific policies to ensure that in both the childcare and nursing home sectors, there will be an equitable local and regional spread of affordable quality services;

in the case of childcare services, calls on the Government to:

- increase core funding rates in line with inflation;

- ensure that the fee freeze for all childcare services remaining at historical levels must be reviewed, so that there is a level playing field between new and existing childcare services in regard to the capping of fees;

- accept the accounts that are prepared, submitted and accepted by Revenue, and not to insist on a second set of accounts under CFCA, which is proving very costly in terms of time and accounting fees, thus pushing many childcare providers over the brink;

- increase the rate of Early Childhood Care and Education funding from €69 to €100; and

- index link funding in future budgets to provide for increases to allow for new employment regulation orders for staff each year, additional staff cover due to required ratios, increased sick leave, and pension auto enrolment; and

in the case of nursing homes, further calls on the Government to:

- put in place an immediate "stabilisation fund" of €265 million to sustain local nursing home services and to stabilise the sector;

- reform Fair Deal pricing so that Fair Deal rates are based on resource allocation that reflects individual residents' care needs;

- guarantee the sustainability of the sector by ensuring a balance between the financial viability of providers, compliance with regulations covering health and social care needs, and the strategic planning of supply to meet demand across the entire country; and

- ensure equity of access to the provision of services including physiotherapy, speech and language therapy, occupational therapy and equity of access to aids and appliances for all older people, regardless of whether they are in a public, private or voluntary nursing home.

On behalf of myself and my co-signatory, Deputy McNamara, I thank the Ceann Comhairle for the opportunity to introduce this motion. In it, what I have tried to evaluate are the challenges facing two vital sectors, namely, childcare and nursing home care. I decided to group the two together because quality, accessible and affordable childcare and nursing home care are indispensable parts of the fabric of any well-functioning society. These services support individuals at both ends of their lives through either early education and care or end-of-life care. They also support families in managing care and support our societal model as we live our everyday lives. As such, they are crucial to the wellbeing and functioning of our communities.

Another important aspect of these care services is that the State plays a significant role in funding them and laying down rules, regulations, requirements, quality standards, etc. That is exactly as it should be. However, putting in place new and appropriate extra requirements, for example, a better ratio of adults to children in a childcare setting or a similar extra requirement in a nursing home, means that the additional costs have to be factored into State support levels. If they are not, the cost base increases and incomes do not, which can lead to trading difficulties and closures. I wish to make it clear that I support extra safety and quality requirements, but we have to recognise that they must be paid for.

I also grouped these two sectors because of the trend in both closures of small, medium-sized and often family-run providers. This has two outcomes. First, the loss of services locally and regionally leads to local and regional imbalances in the provision of such services, local job losses and a loss to local economies. While some other services do open, it tends to be in larger towns and cities, meaning services are no longer accessible locally. Second, large multinational providers gain larger slices of the markets. This has its own implications. If we want to see what some of those are, all we have to do is look across the water to our neighbours in the UK and the US. In an overall sense, I see a trend in Government policy in these two crucial sectors towards overseeing the closure of more smaller services, often being run by one, two or three family members, in urban and rural areas and their replacement by larger companies. Those are often multinational companies and are almost always located in urban areas, causing regional and local imbalances in accessing these vital services. My father and late husband each opened and ran small businesses. Many of my siblings are self-employed as well. Maybe that is why I have respect for people who run small businesses. For them and, crucially, the communities their businesses serve and the locals who rely on their services, I do not want to see any Government policy or set of policies contributing to the closure of their businesses.

That is the overall thrust of this motion, but I wish to discuss some specifics, starting with childcare. Just today, the Federation of Early Childhood Providers, with a membership of more than 1,400 early years services, published a compilation of hundreds of letters from frustrated, hugely disappointed and extremely annoyed childcare providers. There were 300 letters from a total of 500 received. Their message is straightforward, that being, their sector is teetering on the brink of collapse. This report with its book of letters, entitled “United We Stand”, will be presented to the media, Government officials and the Department of children this week in a unified plea from a sector that says it is at breaking point.

A few remarks in the report paint a grim picture. According to it, women comprise 98% of the sector and it is soul destroying to see so many women being pushed out of business and, crucially, so many parents scrambling for services. Women and men will have to leave the workforce because of a lack of childcare. The report states that childcare providers feel bullied, which is a word that comes up repeatedly. They complain of being over-regulated, answerable to multiple agencies that do not communicate effectively, and constrained by financial pressures that compromise the quality of care. According to the report, there is insufficient funding, particularly for State programmes like ECCE, which is the early childhood care and education system. The providers say this is threatening the viability of their services.

What do they say are the main challenges leading to the closure of so many smaller services? Twenty-eight have announced their closure in the past two weeks alone. That is on top of 130 independent childcare provider closures in the year since March 2023. A few weeks ago, I attended a meeting in the village of Coolaney in my county. Approximately 1,000 people already live there and many families are moving there. At the meeting, I learned that two of its three childcare providers would be closing this summer. Many others across the county and in neighbouring County Leitrim told me that they were at the end of their tether, dispirited, despondent and disappointed. That is not an exaggeration. Concern was raised that seven services, or 10% of the services in Sligo, would be closing this summer.

Why is this happening and what can we do? While there are a number of serious concerns, I have raised just two in this motion, the first of which is the core funding model, which was introduced in 2022. At the time, providers were asked to freeze their fees in order to access core funding. They were asked to do the right thing by parents because the Government said it supported them during Covid. They did that. The majority of providers have not had a fee increase for several years, with Covid being one of the reasons, but they took the request at face value and froze their fees at 2017, 2018 or 2019 levels. Fast-forward to 2024 and costs, including staff costs - rightly so - and inflation have increased significantly, but there has been no increase in core funding. The issue is not that simple, though.

Those who did the right thing have had their fees frozen at 2017 or 2018 levels but any new groups that are opening, which tend to be larger chains that are moving into the market, can access the same level of core funding per child as a smaller provider but can charge higher fees. This is essentially wrong and anti-competitive and in many cases, it is squeezing out the smaller providers and, of course, those providers that did the right thing in the first place.

The other issue is the requirement for their accounts to be signed off by a chartered accountant. Pobal will not accept a set of accounts that Revenue will accept. Is this bureaucracy gone mad? I always thought that there was no higher power than Revenue except, perhaps, God. The Department of children and Pobal are on a higher level, however, and will not accept accounts that are acceptable to Revenue. This is bureaucratic madness with two sets of accounts for what often are very small businesses. One might have ten or 15 children in a service but yet, the accounts have two different timelines. One set of accounts is for Revenue from December to December and the other, for the Department, has to be September to August. There is huge paperwork involved in doing these accounts twice. Moreover, the huge cost of paying an accountant to satisfy the Department's requirements is definitely driving businesses to the brink and is closing some of them down. I have only given the Minister of State a short synopsis of the challenges facing the sector but were they to be sorted, I do not believe it is rocket science to do so, we would have a different situation.

I see childcare like a three-legged stool. Yes, fees have been cut to help parents. More is needed but it is good progress. Wages have been increased and again. more is needed but it is good progress. The third leg of the stool, however, is the providers. They must be able to provide a service and make a living and that is the leg of the stool which is broken.

My proposals are to increase core funding in line with inflation to ensure a level playing field for new and existing services on the fees they can charge, to increase the rate of early childhood care and education funding from €69 to €100, to drop the bureaucratic and hugely expensive madness of requiring two separate sets of accounts and to ask the Department to accept the accounts that Revenue accept.

I now will turn to some of the challenges being faced in the nursing home sector. First, let me say that I have no issue with the amendment tabled by the Social Democrats on ending the HSE recruitment freeze when it comes to home carers and nursing home health assistants, as well as on the provision of a statutory right to home care. That is what we all want for ourselves and our loved ones. We want to live in our own homes as long as possible but we also know that that will not always happen. The HSE itself has forecast that if capacity requirements are to be met by 2031, a further 11,000 beds will be required in the sector. It is it is crucial that we ensure that those beds are available for those who need them where they need them.

Another important point to note is that despite those forecast capacity requirements, spending on the fair deal as a proportion of overall health expenditure has steadily declined over the last decade. Expenditure is not even keeping pace with spending in other parts of the health sector and that tells its own story.

In this motion, I am largely relying on the ESRI's 2024 report entitled, Long-term residential care in Ireland: Developments since the onset of the COVID-19 pandemic, for my statistics and figures because those are independent and verified.

What does the ESRI say? It confirms that independently owned and operated nursing homes, many of which were family-run businesses and which until recently dominated the sector, now only supply 35% of beds. That tells its own story. It also states there has been a marked shift towards a consolidation of nursing homes under larger operator groups, many of which are recent entrants to the Irish market and some of which are financed by international private equity. That is a significant issue. Because of that, the report says that the ESRI identifies regional inequalities in nursing home supply and according to its research, which is based upon future planned development, these inequalities are likely to be exacerbated in the near future.

Bernard Durkan (Kildare North, Fine Gael)
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Is Deputy Harkin sharing her time?

Marian Harkin (Sligo-Leitrim, Independent)
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I was told that I have 20 minutes.

Bernard Durkan (Kildare North, Fine Gael)
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The Deputy following Deputy Harkin has five minutes.

Marian Harkin (Sligo-Leitrim, Independent)
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My apologies. I have loads more to say but I will let my colleagues take on from here and I will finish later.

Bernard Durkan (Kildare North, Fine Gael)
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I call Deputy Connolly to speak now, please.

Catherine Connolly (Galway West, Independent)
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Gabhaim míle maith ag an gCathaoirleach Gníomhach and I thank Deputy Harkin for putting the spotlight on these two issues.

In four and a half minutes, I cannot do justice to this matter but I fully support the concepts behind this motion and, indeed, the Deputy has drawn attention to the ESRI report published in January last and she has read out the consequences of the policy that was brought in by the Progressive Democrats, PDs, and Fianna Fáil - with the PDs leading Fianna Fáil - if we go back in time. I note to the Minister of State that I have said this before. I watched the privatisation of a whole range of areas and while Deputy Harkin has mentioned nursing homes and childcare, there are many more areas. We are now seeing the consequences and the Minister of State has been left with this in her hands. It should never have happened but, unfortunately, it did. I am afraid this was the PD philosophy, which was neoliberalism gone mad. It knew the price of everything and the value of absolutely nothing. We have a complete turnaround now with more than 80% of the sector in private hands and less than 20% in public hands.

On that point, we heard an interesting presentation yesterday that I must mention from the trade association The Alliance: Supporting Nursing Homes. I will come back to the Minister of State in that regard as the alliance highlighted a number of significant issues. I see the Minister of State nodding, which I welcome, and I will come back to her but the alliance represents the smaller groups. I put my hand right up to say I fully support a public model of childcare and public nursing homes but, of course, there also is room for smaller nursing homes in that space and I have no difficulty with that. Indeed the alliance pointed out that since 2018, we have lost 65 nursing homes. As was pointed out by it and by the ESRI, most of them are outside of Dublin in the regions because, obviously, the profit is not great enough for the bigger companies. The Minister of State herself, in her speech in January, acknowledged that a small number of companies own, I think, 40% of the private nursing homes, all of which are based on profit and are making one, and then we have the equity and vulture funds. The Minister of State may not use that word but I certainly do. Once the downturn comes in the economy, we are in serious trouble here.

While Deputy Harkin identified nursing homes and childcare, there are also a number of core services, if we are to describe ourselves as a republic and to function as one.

I am on record for praising the Minister of State on this but her hands are full if she is to undertake the undoing of this policy and to turn it around. There are practical ways of doing that first. Outside of my own area - but I have a particular connection with the person who set it up - is a not-for-profit nursing home in Mulrany. I said that I would mention it at every opportunity I get because it is wonderful. The concept is wonderful, the practice was great and it is struggling. I know that those involved have written to the Minister of State.

If I stay in my own constituency, we have a unit in Carraroe with underutilised beds. It is difficult to get the numbers in this regard, which range from 13 to 18, depending on who one is listening to. I will not exaggerate because there are at least 30 beds empty at any given time in the middle of the Gaeltacht for no reason.

Mary Butler (Waterford, Fianna Fail)
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Is that 13 beds?

Catherine Connolly (Galway West, Independent)
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Yes, 13 beds, at a time when the regional hospital is at absolute breaking point. I know that a Commission on Care for Older People has been set up and it is sort of pushing things. I welcome it and I look forward to its report and its recommendations but there is great urgency to that. We need to do something.

Generally on what is happening with regard to privatisation, it has led to huge problems with no continuity of care or with continuity in home care and, of course, we have never got the statutory right to care, which the Government promised. I believe that was part of the programme for Government. I note the Social Democrats have tabled an amendment to the motion and I fully agree with it. If I stay in Galway for my last couple of seconds and if the House forgives me for being parochial, if we get statutory home care and get the home care right and if we get public nursing homes, together with a number of smaller family-run nursing homes; we will balance up the health system and take the pressure off the hospitals that are at bursting point.

The situation in Limerick is so bad that it leaves Galway in its shadow, but Galway hospital is not much better. It is at crisis point every day. Again, there is no blame for the staff but the consequences for staff and, more importantly, for patients are awful. At the same time, there are 13 beds empty at Carraroe and beds empty at Merlin Park and elsewhere. I have no idea why Clifden hospital has closed when it could take the pressure off. I will conclude as my speaking time is up.

Mary Butler (Waterford, Fianna Fail)
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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.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister of State. Next, I call Deputies Joan Collins and Thomas Pringle, who are sharing ten minutes.

Joan Collins (Dublin South Central, Independents 4 Change)
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I thank the Cathaoirleach Gníomhach. First, I thank Deputy Harkin for bringing this motion to the Dáil Chamber today. It is a very important discussion to take place. The Minister of State really only referenced the nursing home area in this, and the motion also raised the issue of childcare.

Mary Butler (Waterford, Fianna Fail)
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I am sorry. The Minister, Roderic O'Gorman will address all of that in the closing.

Joan Collins (Dublin South Central, Independents 4 Change)
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Okay.

Mary Butler (Waterford, Fianna Fail)
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The Deputy may not have heard me. Because there were two different Departments, we decided to split it that way, if that is okay.

Joan Collins (Dublin South Central, Independents 4 Change)
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That is no problem. I did not hear the Minister of State say that. I generally feel that what we are seeing in our childcare and nursing home sectors are the same old repeated failures of this Government and successive governments under Fianna Fáil and Fine Gael, with the PDs wagging the tail of the dog a few decades ago with their neoliberal agenda of privatisation of our public services, mismanagement and bad planning, failure to engage with the stakeholders that matter and a determination to put big businesses' ability to turn a profit at the heart of every policy and decision.

We have a childcare sector that is losing an average of 100 providers a year and a nursing home sector that needs 11,000 more beds by 2031 but is facing what providers have called a tidal wave leaving our fair deal scheme. There are more and more closures while both sectors experience growing demand. This will only get worse. We have a funding model that ignores the reality of the world around us. As has been said, studies by the ESRI show that spending on the fair deal scheme as a proportion of overall health expenditure has declined over the past decade. We know that small and medium providers in both the childcare and nursing home sectors are being priced out of the market, unable to compete with the big international providers that can absorb the cost of inadequate core funding and extra regulations.

Further than that, there is the inadequacy of core funding. Funding has failed to keep up with inflation. The cost-of-living and inflation crises have put severe pressure on everyone, and yet in most cases core funding has not been increased to reflect that need. It is not rocket science to know that when costs go up and funding remains the same, then you get problems. This goes across the board, from funding to wages, pensions and social welfare. If payments do not keep up with inflation, then ordinary people lose out.

There has also been a clear failure to engage with the stakeholders who matter, particularly with regard to the childcare sector. I have received numerous emails from small, at-home childcare providers noting that there has been a clear lack of engagement on the new childminding regulations. Here is a quote from a submission that an at-home childminder made on the new draft regulations. She said:

It is extremely frustrating to be asked to consult on a document where we have put zero input. To be asked now, as the regulations have been decided for us and then be told that we are only allowed to consult on certain aspects, is insulting. Many of us are working in this field for over a decade and many for longer, yet the experience that we can bring to establishing a regulated service in childminding has largely been ignored. We have a wealth of experience out there, both in terms of childminding and of running small childcare businesses, and yet the Government decides to plough ahead without consultation. No wonder there are so many closures of small and medium providers when the Government is not including them in planning or the regulatory process. The result of all this is that you are pushing out small and medium providers. This is largely to gain large private providers, often new entrants to the Irish market, often owned by international investment companies who are making profit hand over fist. For nursing homes, we now have 30% of the market run by independent providers, often family-run or small-scale providers. In childcare, the vast majority of the 100 closures we are seeing every year are small and medium-sized services.

This really is the same old story from Fianna Fáil and Fine Gael. The profits of the wealthy at the expense of everybody else. The difference now is that it is really starting to bite for small and medium businesses as well as for ordinary people. We need to stop providing services, which should be public anyway, by allowing a big business to run wild, making profits at the expense of quality of service and at a cost to the average person.

Thomas Pringle (Donegal, Independent)
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I thank Deputy Harkin and her staff for bringing forward this very important motion on the challenges facing the childcare and nursing home sectors. I support this motion and its calls on the Government to put in place specific policies to ensure that, in the childcare and nursing home sectors, there is an equitable local and regional spread of affordable quality services. I am going to concentrate on childcare in my contribution but it is across the board, as the Minister of State said earlier.

Unfortunately, I have recently been made aware of numerous early childhood education and childcare services that are closing their doors for good in June. This includes full-day, part-time and ECCE sessional-only services. It has also been brought to my attention that there are services on the Tusla register that have been closed for up to two years now. Tusla has been notified, so these should have been removed at the time. However, somehow they are still included as operational because they have not been removed from this register. Can we rely on or trust the figures we are being given with regard to closed services?

Our childcare sector is in crisis. Childcare providers are struggling with a severe lack of funding and a lack of qualified staff available. Social Justice Ireland has reported that one out of every two childcare workers earned below the living wage rate for 2021, despite the increasing demands on childcare workers to improve their skills and qualifications. Many childcare services are experiencing issues with degrees and qualifications now not being recognised and are subsequently losing out on funding. This will have dire consequences for the viability of childcare services going forward.

Childcare providers also need to be able to hire SNAs, who have some kind of experience, to work with children with additional needs. Childcare providers cannot be inclusive and ensure safe levels of staff at the same time. When children go to primary school, they are provided with an SNA and this should also be the case for childcare facilities.

Childcare providers have repeatedly communicated their needs and it is on the Government now to address those needs. The Government needs to increase the rate of core funding and end the fee freeze immediately for those signed up to core funding, especially those who have been in an historical fee freeze since 2017. The Government needs to increase the rate of ECCE funding from €69 to €100, restore the title of educator to the professional workforce, end the command-and-control system, exempt early years services from commercial rates, streamline inspection processes and reduce excessive administration across all areas.

The additional request for a second set of accounts, following the introduction of the core funding chart of accounts financial reporting requirement, is proving very costly due to the time required and the accountancy costs, pushing many childcare providers over the brink. To my knowledge, no other partly Department-funded business is asked for this and it creates a huge financial and administrative burden on childcare providers. As has already been said, they are already doing accounts for Revenue so that should suffice.

Future funding should allow for increases in EROs for staff each year and take into consideration additional CPD, staff cover due to ratios, increased sick leave and pension auto-enrolment, as well as non-contact time required for administrative tasks. NCS subsidies for parents should have the same start and end date for all children, in line with Government scheme programmes. The Department also needs to allow time for administrative input into the NCS children's childcare identifier code key and to pay retrospectively up to a few weeks, as it is not always possible to get parental approval for this on time. The NCS subsidy amount per hour should remain the same for every child and should not vary at different times of the year or due to the child's date of birth or other factors.

Parental subsidy increases via the NCS announced in the budget last year should also have been implemented from January and parents should not have to wait until September to see this increase, especially given that many are severely affected by the cost-of-living crisis.

It is also extremely unfair that the Department would scale back the NCS parent subsidy if there are irregularities in attendance, with the service being penalised. A booked space is a space and provider overheads do not diminish that. All children of any age who are attending an early years’ service should have access to support for their required hours and not just ECCE-applicable children. The access and inclusion model for children who require support needs to be increased again in line with staff employment regulation orders, ERO, and wages. A huge issue is also that childcare providers are tied to the ever-evolving terms and conditions of the Department scheme's draft contracts. This leads to a lack of transparency and consultation in what is supposed to be a two-way partnership.

The Government needs to start listening to the childcare providers and workers who have been trying to communicate these issues for a long time. If we want a fair and equitable society, we need to ensure that our citizens have access to essential services. These should preferably be State-funded services, but at the very least they should be accessible and affordable services offered by providers and workers who are properly funded and supported.

Patricia Ryan (Kildare South, Sinn Fein)
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As the Sinn Féin spokesperson on older people, I am delighted to speak in broad support of this motion, and I thank the Independent Group for bringing it before the House. According to the 2022 report by Age Action, “Reframing Ageing - The State of Ageing in Ireland 2022”, one in four adults in Ireland is aged 60 or older. When expressed in numbers, that is more than 1 million people. These are individuals with their own identities, life experiences and stories, with different needs and aspirations. Irish people are now living for longer than ever before and the number of people over the age of 65 is expected to double to 1.5 million by 2051. It is essential that we not only have people living for longer, but that those people can live as well as possible. When older people need or choose residential care they need to be sure it is fit for purpose and affordable and can provide whatever level of care they may need in their golden years. After all, nursing homes are not just buildings or businesses; they are homes to those who live in them, as the Minister of State and I both know.

More than 80% of the 32,000 nursing home beds in Ireland are provided by the private and voluntary sector. They are funded by the National Treatment Purchase Fund, NTPF, and fair deal schemes on a bed, board and laundry-care model. This is very basic and does not allow any wiggle room for extra expenses. God forbid, a resident in a nursing home under the fair deal scheme needs an occupational therapist or a physiotherapist. They better have the means to pay for it because the scheme does not cover any of it. If the pressure becomes too much and the nursing home closes, residents will find that foreign multinationals are only too eager to add to the 40% of private nursing home beds they already have in their hands.

The care of our older people should not and cannot come down to a race to the bottom for the lowest cost and the organisations that make the biggest profits. Older people’s care is not and should not be a commodity to be traded off to the lowest bidder. It has to be about quality of care and not quantity of profit. Given the added stress of the staff recruitment and retention crisis and the lack of parity of wages, this is a recipe for disaster. Change needs to happen now before it is too late and Sinn Féin in government would bring that change. For example, we would ensure the NTPF is sufficiently resourced to negotiate viable pricing for those nursing homes that are operating at a loss due to unreasonable price pressures and increasing complexity of care costs. We would future-proof the model of care for older people through a commission on care, ensure a living wage for nursing home sector workers and put forward a collective pay agreement. We would address the viability of loss-making nursing homes through a review of the fair deal pricing mechanism - one size does not fit all - by ensuring resources are allocated on the basis of individual residents’ needs and not just a bed, board and laundry basis. This would prevent a race to the bottom regarding cost and quality.

Our elderly and older people have suffered enough in recent years and the scars of Covid-19 are still fresh. I have asked several times when we will have a commencement date for the Covid-19 inquiry. Will it be in the lifetime of this Dáil? Will those who are seeking justice and closure for their loved ones in this case have to wait for years to be recognised?

Yesterday, I hosted Shane Scanlan of The Alliance and his guests in the audiovisual room. Like the Leas-Cheann Comhairle, I will have some questions on that.

Mark Ward (Dublin Mid West, Sinn Fein)
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Yesterday, alongside my colleague, Councillor Daithí Doolin, and other public representatives, including Members from both sides of the House, I stood in solidarity with the families of residents of the willow and sycamore units in Cherry Orchard Hospital. The families I met yesterday have called for urgent action to be taken by the CEO of the HSE and the Minister to address their concerns.

As the Minister of State will know, in November last year, 68 residents and their families were told the residents would have to be moved out of their homes. Information I received in November highlighted that there were structural problems in the units. A response I received from the HSE on 14 February, Valentine’s Day, stated there were no significant structural problems. As I said previously, something does not add up here. The residents, families, loved ones and staff all need clarification.

To my knowledge, 33 residents have been moved so far and 16 remain in Cherry Orchard Hospital. Sadly, 19 of these families have since been bereaved. From speaking with families yesterday, they feel that the stress of moving, or the threat of moving, has caused undue duress for their loved ones. The majority of the remaining residents suffer with dementia. It is widely acknowledged that moving elderly residents with complex needs, including those with cognitive impairment, can cause transfer trauma and other detrimental health problems. The residents with dementia were familiar with the staff and their surroundings. In fact, the first time I heard of this issue, the information did not come from the families but the staff. To their credit, the staff were more concerned about the impact of the move on residents than they were about their job security.

Maria Stynes’s 96-year-old grandfather, John Sweeney, is one of the residents who remains in Cherry Orchard Hospital. Yesterday, Ms Stynes read from a letter addressed to Bernard Gloster, the CEO of the HSE. She wrote:

For 27 weeks now we, as advocates, have tried to communicate concerns and resolve the issues ... At this time families feel bullied and disrespected and no longer feel comfortable negotiating our loved one’s care and needs and wishes further with the current team in place.

She added that families of the residents at Cherry Orchard are deeply concerned about the impact of recent transfers. She believes these transfers were coercive and created undue stress and trauma for the residents and their families. Today, before this debate, I spoke with Maria again and she informed me that the group has evidence that the decision to close the units came from the HSE and not the Health Information and Quality Authority, HIQA. I have submitted parliamentary questions seeking clarification on this but I am hoping the Minister of State may be able to clarify it today.

The group has three requests. It asks that the remaining residents be kept on-site in Cherry Orchard Hospital in the completed safe rooms within the willow east building. I ask the Minister of State to give this proposal serious consideration. It could end the stress the current residents are experiencing. The group is also calling for a comprehensive independent investigation into the human rights implications of the process. It is calling on the CEO of the HSE to work directly with it to ensure a satisfactory solution for the remaining residents, as well as appropriate recognition for those who have passed away. I urge the Minister of State to directly address the families’ concerns and ensure the voices of the residents are finally heard and heeded by the HSE.

Care Champions, an organisation that has been steadfastly supporting families, believes that the current process disrespects the Assisted Decision-Making (Capacity) Act and lacks transparency, planning and family involvement. I previously asked the Minister of State directly to meet with the representatives of the families. So far, that has not happened. If she is sure that moving these residents is the right thing to do, at least she wold be able to stand over that view, meet the families face to face and have a conversation with them.

People with acquired brain injuries are being moved from Cherry Orchard Hospital campus’s lisbri unit. Residents are to move out of congregated settings, which is in line with the Government’s policy, but sometimes there are unintended consequences of this. I know of a family whose mother has been in the unit for 15 years. She is moving back to the family home and will get support in the home, but because her daughters cannot live with their mother, they are being made homeless. Two daughters and a grandchild will be made homeless as a result and they feel their voices were not listened to when they raised the issue with the HSE before the decision was made to move their mother from the congregated setting.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
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I will speak briefly to both sectors in question. What they have in common, and the motion speaks very clearly about this, is how when public goods and what should be public services are left to the private sector to the extent that they have been, you limit your levers and influence over them. The Government has many levers and influence over them, but it would be far more preferable to look at these properly as public services once and for all.

That is the direction of travel we need in both of these areas. That will not happen overnight but it should be the direction in which we move.

We had several debates last during the course of the last year on nursing homes, in particular Beaumont. People have concerns over the funding model and that needs to continue to be examined. More strategically, we need to significantly increase the number of beds that are provided through the State system and through the community system for nursing homes. There is a severe shortage there. While it is a somewhat different issue, it is not entirely unrelated to the pressure on our hospital system. Too often people are in hospital longer than they need to be because of a severe lack of step-down beds but in some instances also because of a lack of long-term and respite nursing-home beds. The respite piece is particularly significant.

There are similar challenges with the childcare sector. I have been speaking on this for years. This is having a huge impact on families throughout the country and not just in terms of the cost. Even when money is not an object, which obviously it is in a cost-of-living crisis, for those families who have enough money to pay for it, to be able to find a place anywhere in the country but particularly in the big urban centres in Cork, Dublin, Galway and Limerick - I speak particularly for Cork - it is extremely difficult. God forbid that parents would look for anything beyond the very standard end. Looking for something other than the exact five days or for a place for a child below one year of age is even harder again. Baby rooms are effectively gone. There were many more of them even three or four years ago. However, because of how the funding model is structured, many providers have removed those services, which is making it really difficult for women and parents generally to return to work or to find work. That means parents without a support structure living far away from their families are delaying returning to work which not necessarily what they want to do. It is in some instances, but for many parents that is not what they want to do. They are forced into staying out of work because of economic necessity which is wrong.

Somebody was in contact with me for whom three days a week was what suited them because of their financial and work situation. The provider advised that because of how things are structured administratively and financially, they needed to either provide a space for five days or not at all. This person was left with a choice of trying to find an additional €185 a month or have no childcare. Part of that was because of the structure. All these issues need to be looked but in the longer run we need to be working towards a public service because it is a public good.

Martin Browne (Tipperary, Sinn Fein)
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I want to speak on the Government’s appalling attitude towards the elderly in this country. I am speaking against the backdrop of the suggested repurposing of the new community nursing home in Nenagh as a step-down facility to take the pressure off University Hospital Limerick, caused by Government failures. I am also speaking in the wake of the repurposing of St. Brigid’s Hospital in Carrick-on-Suir, only to be subsequently closed for good. There continues to be uncertainty about the future of the Dean Maxwell community nursing unit in Roscrea. I can only speak on the Government's record and what is happening in my county of Tipperary which is appalling. Considering this, I am really concerned that a similar situation will happen in Nenagh whereby it will never revert to its original purpose if the ham-fisted plan goes ahead.

I will be raising this during the Topical Issue debate. I am glad the Minister of State, Deputy Butler, is actually appearing. We were told earlier that the Minister of State would not be here. The residents of St. Conlon’s, the workers, the unions and the community are opposed to the Government's plan. There are real concerns that if this happens, it will never revert to the purpose for which the people of Nenagh have been waiting for a decade - to provide 50 beds for the care of the elderly.

The impression that the HSE and the Department of Health are trying to give is that there has been adequate engagement with residents, workers and unions. Nothing could be further from the truth. Residents are outraged over claims that they were consulted. Unions are also unsatisfied with how the Government is presenting this.

This is another example of the elderly being expected to shoulder the burden of a health system that appears to put them last while it struggles with the consequences of the disastrous reconfiguration of services in the mid-west. Why are the elderly the ones who the Government and the HSE wish to deprive of 50 beds at a time when the older population is increasing and when the residents of St. Conlon’s who were due to be transferred to the new unit had looked forward to their new surroundings? I urge the Minister of State to rethink this. Does she think the current number of places in public nursing homes, which is 1,000 lower than in 2014, does not matter and that older people should be the first to be sacrificed to cover up the cracks in the health system?

Older people want and need affordable, fit-for-purpose residential nursing home care. Ireland has the fastest growing age demographic in Europe. As such, Sinn Féin wants investment in 1,200 public nursing home and community beds to speed up hospital discharges and provide more care in the community, not to remove beds as is proposed. There is inequality within the system which we believe can be reformed through a range of measures, including the reform of the fair deal scheme to support regionally balanced investment.

Finally, I want to address childcare. In Nenagh again, I have been informed of a service provider who claims that the subsidy given by the Government is putting their livelihood in jeopardy. They are struggling with costs, but they do not want to heap the burden on parents. If a shortsighted attitude towards the childcare sector is not immediately addressed, parents will be without a provider. Where will that leave people?

We need a holistic approach that works. That is why Sinn Féin would make childcare affordable for parents and beneficial for providers by increasing funding by €201.7 million to enable providers to reduce fees for parents, underpinned by legislation and controlled through contractual agreement with providers.

I ask those on the Government benches take heed of the messages we are giving them here. They should not hide behind statistics that avoid addressing the real issues on the ground.

Jennifer Whitmore (Wicklow, Social Democrats)
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I thank the Independent Group for bringing forward this really important motion. Most families across the country have experienced pressures either from a childcare perspective or from an elder care perspective so this really important motion. I will cover both aspects of this motion today.

Regarding elder care, in January the ESRI found the 74% of all nursing home beds were provided by private providers which is 14 operators providing 40% of all beds nationally. Those figures should have set off alarm bells in the Department regarding the consolidation of nursing home ownership, but instead we get more of the same - express concern but do nothing.

I accept that the commission on care has finally commenced which is welcome but major shortcomings in the current model of care have been evident for some time. The impact of the pandemic should have led to a more community-focused approach to long-term care, but the over-reliance on private nursing homes continues. Increasingly we are seeing this wealth extraction facilitated and even encouraged.

Large nursing home operators, many of which are financed by international private equity, now dominate the market which is forcing more and more independently owned nursing homes to close their doors. Between February 2020 and December 2022, the ESRI found that almost one in five smaller private nursing homes had shut down. This rapid decline disproportionately impacted rural areas. I am equally concerned about the lack of available alternatives to nursing home care such as home care and new models of supported housing. A statutory right to home care was supposed to have been delivered in 2021. This was then pushed out to 2023 and now in 2024 we still do not even have the heads of the Bill. It is not even listed for priority publication in this Dáil term.

While home care hours and funding have been increased since 2020, waiting lists remain stubbornly high. In February more than 5,500 people were approved for a home care package but no carer was available. I do not know if the Minister of State has ever had the experience of getting a letter through the door to say that a loved one is entitled to care but unfortunately there is none to give them. It is heartbreaking when that happens.

These staffing challenges have only been made worse by the regressive HSE recruitment freeze. February's progress report on the implementation of the strategic workforce advisory group report showed that three of the 16 recommendations are on hold due to the recruitment freeze. This includes recommendation 11 to significantly increase the proportion of home care hours provided directly by the HSE. This is just another example of the Government's shortsighted thinking leading to rampant outsourcing of services.

The perennial crisis in health and social care services will not be resolved by starving the HSE of funding. Decades of underinvestment in public healthcare infrastructure got us into this mess and the solution will not found in repeating that mistake. My Social Democrats colleague, Deputy Shortall, has tabled an amendment to that effect and I hope this can be supported when the motion is put to a vote.

Regarding childcare, the fundamental problems that we see in both elder care and childcare in this country pretty much stem from the same basis and that is the fact that these are, and should be, fundamental public services that we are somehow trying to squeeze into a private hole and it is not going to work, When trying to make changes to that system, they are done in a piecemeal fashion and that does not solve the problem. While I welcome the Government's focus on childcare, and I acknowledge the Minister, Deputy O'Gorman, has done a lot of work in that area over the past number of years, it is just never going to be enough. He is never going to fundamentally fix the issue of childcare provision in this country by purely working within the current system because the current model is not the model that will deliver best for parents or, indeed, staff and providers across the country. Ultimately, we should be move towards a public model of childcare provision, which is where the Social Democrats believe we should be going. It is only once we get to that point that these issues will be resolved. I acknowledge there have been efforts by the Government to focus on the cost element. It has not gone far enough. It has not made as much of a difference in people's lives as it should have but I welcome these steps. It is not just about cost; it is also about availability and flexibility. The reality for many families throughout the country is that there just is not the availability of childcare provision. The downside and the pressures this brings on families is placed primarily on the mothers. What it means is that oftentimes mothers are unable to return to work because they cannot either find or afford childcare.

I am going to refer to Wicklow because it is my constituency and not a week goes by where I do not have contact from a parent or indeed a provider in the county who is expressing concern about the direction of travel within childcare and telling me about their own particular experiences when it comes to this issue. I recently spoke to a mother who is a teacher and she cannot go back to work. Despite signing up for childcare provision for her baby when they was born, paying a deposit and being promised a place from August 2024, she found out in the past month that this will not be available for her until 2025. The knock-on impacts of not having that provision available is incredible because not only will that mother be at home now but we are also down a teacher. The impacts are clear. There are fundamental structural elements that need to be changed.

The other issue that comes up frequently for me is flexibility. We have reached a point where many people work from home maybe one or two days per week but if they are with a crèche or a childcare provider, they often have to pay for the full five days. That puts enormous pressures on and negates the benefit of someone being able to work from home a couple of days per week. Something we need to consider when we are looking at the childcare model is exactly what we want and who it should serve. Ultimately, it should serve parents and children. Once we get it right for them, we will get it right for everyone. We need an affordable and flexible service that is easily available to people, not something that they have to essentially put their names down for before the baby is even born.

Another issue I have experienced locally is that the current reforms are preferencing the larger providers and disadvantaging the smaller providers. Even within the larger providers they are disadvantaging the less profitable aspects of it. A number of after-school services close down, which again means that many mothers are restricted in where and when they can work. There are all these small knock-on effects and we need to examine the childcare sector as a whole to make sure we provide a service that is fit for everyone and meets everybody's needs. Ultimately, the Social Democrats and I believe that until we get to a point where we have a fully publicly provided childcare system, we are really just tinkering around the edges and will not get it right for anyone.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Deputy for that contribution. We move now to the Minister, Deputy O'Gorman. I thank him for being here. He has ten minutes should he need it.

Roderic O'Gorman (Dublin West, Green Party)
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I welcome this motion as an opportunity to debate the important issue of early learning and childcare and I will focus on that element. I acknowledge my colleague has focused on the issue of nursing homes and elder care previously. It is clear from this debate so far that we all recognise the importance of early learning and childcare for children and their families, and for our wider society and economy as well. In opposing the motion and in supporting the Government amendment, our objective is not to claim that there are no challenges in the sector. There absolutely are challenges. However, it is rather to demonstrate that the Government has set out a pathway to address these challenges. It is also to demonstrate that the Government has made significant strides in this regard. Indeed, the European Commission recently endorsed our approach and has welcomed the very substantial progress that has been made in the early years sector.

This reform work has been backed by extremely significant investment, which exceeds €1.1 billion this year. It is important to say this is in a context of when I started as Minister the investment in this second sector was €638 million. That is a 72% increase in investment in a four-year period. Very few Departments have experienced that steep an increase in investment in such a short period. We have used this new investment to introduce a new funding model that has been designed to address the most challenging issues the sector faces. This funding model, together for better, recognises early learning and childcare is a public good that demands more investment and more involvement by the State and a closer working partnership with providers with new responsibilities on both sides. It brings together a number of existing and new schemes, including ECCE, the one we know best; the access and inclusion model, AIM; the national childcare scheme and the subsidy given to parents to cut their fees; the new core funding scheme to support providers; and with a further programme Equal Start, which I will launch later this month and will roll out in September, which is basically a DEIS-type model for early years. We will introduce that for the first time and it is something we are very excited and proud to be bringing forward.

While only in place since September 2022, we are seeing substantial benefits for children and their families, the early learning and childcare workforce and providers. For example, the national childcare scheme provided a subsidy increase in 2022 and in 2023. It is supporting a record number of children and additional funding I secured in this year's budget will apply from September of this year. That will have meant in two years I will have on average cut out-of-pocket costs for parents by 50%. The universal ECCE programme is supporting more than 108,000 children to access preschool education. The award winning AIM is then supporting 7,000 children who have additional needs and who have an intellectual, physical or sensory disability in order that they can access the ECCE programme. It is a really good model supporting integration within our early years system. We will be able to increase the number of hours offered through AIM this year for the first time in a significant period due to increased funding that I secured in this year's budget. Core funding originally had a €259 million allocation in its first year. That has grown to €287 million this year and in year 2 that has allowed for a fee freeze in 94% of services. That means that when we increase the subsidy to the parent via the NCS, they will immediately feel the full benefit of that subsidy. The introduction of core funding has led to a 20% increase in the number of services that are signed up the NCS. Those parents using these services will be able to benefit from that subsidy. There has been a 52% increase in the number of sponsored children and a 100% increase in the number of children benefiting in the past two years alone, which has substantially widened access to this State support. This core funding has also supported the agreement of an employment regulation order for the early years sector.

That secured a pay increase for 73% of the workforce for childcare professionals in September 2022 under an employment regulation order agreed at the Labour Court by a joint labour committee. It has extended support for graduate-led provision outside the ECCE programme and led to sustainability and stability in the sector. There is now a minimum core funding floor of €8,150. No service gets less than €8,150 extra through core funding, which we introduced.

Together for Better is about ensuring stability and sustainability in the sector. I am strongly committed to that. I do not want any service to be faced with financial sustainability issues. I am fully committed to working with any such service to support them in delivering early learning and childcare for the public good. The allocation of core funding in year one and year two far exceeded the rate of inflation for those years. With ECCE capitation and core funding combined, services now receive a minimum of €78.20 per child per week under the ECCE programme and a maximum of €95.85 per week, with additional funding for graduate lead educators and graduate managers. In addition to this, small and sessional services benefit from targeted measures which I introduced in 2023 at a cost of €7.2 million, specifically, a flat top-up rate of €4,075 for sessional-only services and the minimum base rate allocation of €8,150. These measures saw the average allocation under core funding for sessional-only services increase by 30% that year. In year one of core funding, we just allocated according to capacity in hours used. In year two, we recognised that there were certain smaller, part-time services that needed additional support. We used our extra funding in year two to channel specific supports to those services. In September, we will move onto year three of core funding. I have an extra €44 million - a 15% increase in the level of core funding in year three. We will target and tailor it to allow for growth in capacity, as many services are opening up more places, which is good. We all know that capacity is a real challenge. It is also about using that money to support existing services, particularly those that may not be as profitable and have challenges with fixed costs and have found it hard with the cost-of-living crisis and the increase in rent and energy costs over the past number of years. That extra €44 million will support the delivery of a range of enhancements in year three of the scheme and, in conjunction with the targeted measures I introduced last year, will improve the financial standing of services with the lowest income levels. It will also pave the way for further pay increases for early learning and childcare professionals through a further employment regulation order, which we hope to see agreed in the next number of weeks. That will be a second agreed pay increase - the only time that has ever been achieved. Given the scale of Government funding, I stand behind the need to have validated financial returns. This is important as it assures the Government and the public that the extra public money we are investing is being put to that important use in delivering high quality, affordable and accessible early learning and childcare. Getting the financial returns also gives us evidence of how we use that extra funding. It allows us to identify that there may be certain types of service that are not doing as well and the extra money we have through core funding in year three could be targeted towards better supports for them.

That funding work does not take place in isolation. It is part of a wider set of measures which we are bringing forward. There is Nurturing Skills, the workforce plan, which is all about ensuring that people thinking of entering the early years profession can see a career pathway, an ability to improve their qualifications and, as such, get higher levels of pay, and that they have a future in that sector, which is important. There are recruitment pressures. I recognise that. There is a new scheme to help to encourage early years professionals to take up higher levels of degrees. The State will meet a significant part of those costs. That is all part of supporting recruitment and retention. There is the national action plan for child-minding, which is to allow parents who use childminders to draw down the NCS in the new appropriately regulated sector. There is the Building Blocks capital programme, which recognises that there are challenges on the capacity side. It is about the State bringing money in to support the expansion of existing services. There will be an allocation for that this year and a larger allocation in 2025, which I have been able to secure under the new national development plan.

To conclude, I have focused on three key issues since I became Minister: sustainability for providers; improving pay for early years professionals; and reducing costs for parents. We have made substantial progress in all three areas. There are still real challenges across all three. We have a new challenge with capacity. We are looking to address that as well. My final point is that early years education in Ireland only started to get State investment in 2008, with the introduction of the first year of ECCE. All the rest of Europe has been investing in this for decades. We are playing catch-up but in a four-year period, we have done a dramatic amount of catching up in investment and reform. I will continue to work with everybody across the sector - providers, parents and staff - to continue to address those challenges, make it a better system for everyone working and, most important, deliver better early learning and care for children.

Marian Harkin (Sligo-Leitrim, Independent)
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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.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank Deputy Harkin, and I thank the Minister and Minister of State for being here. We have been engaged in the best possible use of parliamentary time over the past while, namely debating the issues of childcare and elder care. I could not think of a topic more important to the people we are privileged to represent.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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In accordance with Standing Order 80(2), the division is postponed until the next weekly division time.