Ruairí Ó Murchú (Louth, Sinn Fein)
Link to this: Individually | In context

Bogfaidh muid ar aghaidh go Saincheist Tráthúil Uimh. 4. Tá an tAire Stáit, an Teachta O’Donnell, á glacadh. Fanfaidh muid bomaite amháin ar an Aire Stáit. Tá an cheist seo in ainm an Teachta Colm Burke.

Colm Burke (Cork North-Central, Fine Gael)
Link to this: Individually | In context

I thank the Minister of State, Deputy O’Donnell, for coming into the House at this late hour to deal with this issue. I very much appreciate it. As the Minister of State knows, this is an extremely important issue. It is to ask the Department of Health whether it intends to put in place a national nursing home care policy following on from the recent publication of the new ESRI report, which projects that we need to grow the number of both short-term and long-stay beds in nursing homes, and whether the Minister of State will make a statement on the matter.

I have been involved behind the scenes in the nursing home sector for the past 20 years. In 2004, as a result of a legal challenge – I have mentioned this previously in this House – that a colleague and I took against the Department and the health boards at the time, more than €450 million had to be refunded. This led to the creation of the fair deal scheme. The challenge we now have from the ESRI report is that it clearly sets out the need for a dedicated national nursing home care policy. Short-stay bed requirements are projected to grow from 3,745 beds in 2022 to between 6,420 and 7,265 beds by 2040, which is a growth of between 72% and 94%. Long-stay bed requirements are projected to grow from 29,579 beds in 2022 to between 47,590 and 53,270 beds by 2040, a growth of between 61% and 80%. In fact, if you take the ESRI report, it suggests that we will require a minimum of 21,056 additional nursing home beds over the next 14 years by 2040. That is 1,403 beds per annum over the next 15 years.

To do that, we need a plan. I am not convinced that we are looking long term. Likewise, what happened in 2004 is that there was not a long-term plan. It was a case of saying how lucky people were with regard to the supports they had got and whether they were in a public nursing home or a private nursing home. We currently have 32,000 people in nursing home care. We need to have a national framework setting out a guide to integration of people in nursing homes, a guide to the long-term funding, a guide to the regulation and also rights-based planning. We have seen the recent reports from RTÉ that have highlighted the issues regarding where there is not sufficient support for patients and patients not being treated in a proper manner.

All of the evidence is that we will have a growing number of people over 65. As the Minister of State knows, the age profile is changing. In 2011, we had something like 600,000 people over 65. The last figure was 831,000. Within four years, there will be 1 million people over 65. Therefore, the growth in demand for nursing home beds will come at a really fast pace. We also need to make sure that we have step-down beds to get people out of hospital on time. That is a problem. I ask the Minister of State if we have a plan that we intend to put in place and what the timescale is.

Kieran O'Donnell (Limerick City, Fine Gael)
Link to this: Individually | In context

I thank Deputy Burke for raising this important matter. I know his keen interest in this area. I welcome the ESRI report on future capacity requirements in older people's care, which was published on 30 June and encompasses residential care for older people and home support. The analysis in the ESRI report utilises the Hippocrates model to update baseline estimates of demand in 2022 for residential care, both long term and short term, and projects demand and capacity for these services out to 2040. The ESRI report projects that the number of residential beds, both long term and short term, will need to increase by at least 60% by 2040. The Deputy referred to the findings of the ESRI report too. The research was funded by the Department of Health and considers a range of scenarios based on varying assumptions about population growth and ageing, the effects of healthy ageing and policy choices. The ESRI's demand and capacity analysis will be invaluable in advancing evidence-based capacity planning that is responsive, agile and meets the needs of our older population over the coming years and decades.

People are living longer lives and the number of older people in the total population is growing. The success that has been achieved in improving health outcomes and extending life expectancy must be acknowledged and celebrated. However, we must also recognise the challenges we will face in a range of areas in the coming years as our population ages. The ESRI report sets out that we will need a substantial increase in long-term and short-term residential care capacity to meet the demands of our growing and ageing population.

The Government's long-standing strategic goal is to deliver a new model of integrated older persons' health and social care services across the care spectrum, supporting older people to remain living independently in their own homes and communities for longer, in line with the Sláintecare vision for receiving the right care, in the right place, at the right time. However, it is recognised that care provided in long-term residential care settings for older people will continue to be an important part of the continuum of care for older people into the future. As Minister of State with responsibility for older people, I am very conscious of the importance of strengthening the capacity and resilience of our health system through the delivery of health and social care infrastructure. This Government is committed to continued investment in healthcare infrastructure that supports the highest quality care for our older population.

This investment includes the community nursing unit programme, which was launched to ensure that up to 90 of our public community nursing units and community hospitals would be refurbished or replaced to ensure the best quality environments for our older people, and to ensure HIQA compliance. A total of €4 million was allocated in budget 2025 to staff and open an additional 615 community beds this year in capital projects coming to fruition through this capital programme. The 2025 programme for Government also committed to build more public nursing home beds. The Department of Health, alongside the HSE, is developing a new long-term residential care additional capacity plan, which will be published in 2025. This is an absolute priority for me as Minister of State and for the Minister, Deputy Carroll MacNeill.

As Deputy Burke will be aware, the Government established an independent Commission on Care for Older People in March 2024. The commission is charged with examining the provision of health and social care services and supports for older people, including residential care, and with making recommendations to the Government for their strategic development. I look forward to the first report of the commission, which will be published in the coming months. It is evident that significant further investment will be required by the Government to ensure that the appropriate care services are available for our older population and to deliver on the programme for Government, Sláintecare and Project Ireland 2040 commitments. I am absolutely committed to ensuring that this capacity planning is advanced in 2025.

Colm Burke (Cork North-Central, Fine Gael)
Link to this: Individually | In context

Regarding home care, there is the whole issue of long-term planning. For instance, in 2022, there were 28.7 million hours for home care. The prediction is that by 2040, it will be somewhere between 44.9 million and 54.9 million hours. That is a huge change. One of the problems I have at the moment is the total lack of planning for short-stay beds. We are not producing enough of them and it is causing a huge problem in our hospitals. As we speak here tonight, 50% of all people who occupy hospital beds are over 65 years of age. That is why we need immediate action to develop short-stay beds, through either the private sector or the public sector.

The other issue that I would be concerned about is the inappropriate comparison between the services provided in private nursing homes and public nursing homes. There is a huge gap in funding. The average public nursing home bed is costing €1,969 per week. A private nursing home is getting on average €1,220. There is a gap of €750. In addition, the private nursing home has to pay commercial rates, which for an average 50-bed unit would be around €60,000 per annum. It also has to pay public liability insurance, which could vary between €60,000 and €100,000 per annum. The private sector has to pay huge additional costs that public nursing homes do not have to pay. They are also dealing with the cost of erecting nursing homes in the private sector. We need to look at all this and make sure that we put in place a plan that can be delivered in a timely manner.

Kieran O'Donnell (Limerick City, Fine Gael)
Link to this: Individually | In context

I thank Deputy Burke for raising this matter. He will be aware the ESRI health capacity review on future capacity for care for older people is the third in a series of capacity reviews on Ireland's health services, following reports on public acute hospitals and general practitioner services. The ESRI will publish further analysis later this year. I note the points that the Deputy raises in the other matters he highlighted. The ESRI report provides an evidence base that is crucial for future planning and ensuring we provide the right health and social care services in the right place for our older population.

The ESRI report deals with both long-term and short-stay beds, which I acknowledge. It deals with home care too. There has been significant investment by the Government in home care hours. They have gone up by 70% since 2020. The investment is €838 million compared with €400 million. There is a significant commitment by the Government to home care. At the moment, we are working on development of statutory home care. The first step in that is for home care providers legislation, which I am progressing.

As part of the ongoing collaboration between the ESRI and the Department of Health, the commission is building a demand and capacity modelling capability for our modern health service. I have already stated that demand for health and social care services is increasing as our population increases and ages. Older groups tend to use healthcare services more frequently and for a longer duration. I reiterate that we are making progress in increasing residential care capacity for the older population. In response to future capacity requirements, the commitment to building more nursing home beds is an absolute priority for Government. In this context, the Department of Health and the HSE are developing a new public long-term residential care capacity plan, which will be published this year.

It is something I am very committed to. As I mentioned, the Government has established an independent Commission on Care for Older People. The commissioner is charged with examining the condition of health and social care services and supports for older people including residential care and will make recommendations to the Government for their strategic development. I very much look forward to the first report from the commission, which will be published in the coming months under the chair of Professor Alan Barrett. It is doing a considerable body of work.