Paul Gavan (Sinn Fein) | Oireachtas source

It is good to see the Minister of State. I acknowledge her work and her commitment in this area. I will start by painting a picture of the stark reality facing the health system. More than 2,000 nursing home beds have been lost since 2018, with the closure of 64 nursing homes over the last four years. At a time when hospitals are packed full, when we need step-down beds and residential care more than ever, this trend is only accelerating. Some 17 closures have been announced already this year, which is a loss of more than 500 beds in just the last few months. More nursing homes are considering closing. Many of the remaining 550 nursing homes feel they have few options available to them in the coming years if things do not change.

At the same time, more than 7,000 patients, which is a staggering figure, have been delayed in hospitals for longer than necessary because we do not have the capacity in home care or step-down and recovery facilities to discharge them on time. The Minister of State will know that is a particular problem where I live in Limerick. We lost a fine nursing home in Castleconnell earlier this year, one that provided a key service for local people. It is sadly missed. This is a major driver of delays in hospital admission from emergency departments. There are, on average, between 400 and 600 patients in hospitals every day who could and should be discharged. Greater availability of step-down, recovery and convalescent beds would take pressure off our acute hospitals.

Sinn Féin, if in government, would prioritise investment in the public system. Over-reliance on the private sector was never going to be sustainable. The Minster of State said, rightly, that 80% of nursing home sector is covered by the private market. There was never a national conversation about that. Some 30 years ago, it was 80% public. We must recognise that we need a much greater role for the public sector in the future. I will have more to say on that towards the end of my speech. That is not to say we do not value the role voluntary and private nursing homes play in providing care. What we need is a sustainable funding model. We also need to have a conversation about the fair deal scheme, the pricing mechanism and a sustainable funding model based on the changing nature and dynamics of care, which is happening and which will continue to happen.

I will deal with the issue of inflation costs. This winter, nursing homes, like so many other businesses across the State, face rising costs and inflation across the areas of energy, food and beverages and justifiable pay demands from workers. It is very clear that voluntary and private nursing homes will need to be supported through this unprecedented crisis with total cost certainty. To that end, I would respectfully say that €15 a week per resident falls far short of what is needed when it is clear from independent analysis that costs have already risen this year by more than €190 per resident per week. This increase equates to an uplift of less than 1% in public funding for nursing homes. Nursing Homes Ireland has pointed out that the temporary inflation payment scheme may lead to more closures. This is a challenge for smaller nursing homes in particular, including those run by families, which are essential to their local communities. We cannot countenance losing them or forcing them to turn down the heat. I heard a horrific story about a very cold nursing home in the middle of Limerick just this morning. We cannot afford to have more staff laid off or cut back, or cutbacks in the quality of service offered to residents. While the Minister of State has confirmed that the new TIPS or a separate scheme will allow nursing homes to claim up to €10,000, Sinn Féin does not believe this is the right way to go about it. We need a fit-for-purpose bespoke arrangement that recognises the additional burdens the nursing home sector carries. In the short term, we need support that will keep beds open and keep the heating on.

I make no apologies for highlighting the issue of workers in the sector. Further challenges for nursing homes are staff shortages and retention. There are, on average, five vacancies in every nursing home because of the lack of qualified carers and healthcare assistants. The Government has spent years expecting carers to pop up out of thin air. I acknowledge the difficulties that the sector, especially the workers, experienced during the pandemic. Years of under-resourcing, on top of the health emergency, was a recipe for disaster and the toll on workers and families was horrific. In light of the sacrifices made by workers in this sector, it is beyond a joke that they have yet to be paid their pandemic bonus more than a year since it was first promised. In recent weeks, some of these workers have been contacted regarding making the payment. That is welcome. I hope it will be paid in time for Christmas for all these workers.

We must deal with the issues of low pay and poor working conditions once and for all in order to address the recruitment and retention crisis in residential care. The previous solution of just stopping the HSE from hiring workers from private homes did not work. It was never going to work. The funding model going forward must be underpinned by a collective pay agreement that ensures a common pay standard for workers across public, voluntary and private organisations, from the smallest care home to the largest.I acknowledge that the Minister of State has sought to have the living wage be the new minimum wage in the new HSE tender authorisation model for home care. That is progress and I acknowledge it. We need to go further.

I will not be popular for saying this but it has to be said that one reason there is a problem with recruitment in this sector is because of the poor terms and conditions. Underpinning that is the fact that the vast majority of private nursing homes refuse to recognise trade unions. How can that possibly be justified? How can we have workers in the public sector, who rightly have unions and people to come out and defend them, when the private sector denies those rights? I know this personally. I was a union organiser before I was lucky enough to get in here. Whenever I organised workers in a nursing home, whether in Tipperary or Limerick, they were immediately fired for choosing to join a trade union. I will read out a standard contract from the sector. It states that the company will require workers to work a variety of shifts, which include days, nights, evenings and weekends as part of the workers' normal working week. It states that as the company's primary function is the care of its residents on a 24-hour basis, workers are required to be flexible in their hours of work, as from time to time they may be asked to provide cover for other shifts. It states that their rate of pay includes an additional 3.5% premium which is paid for working a shift pattern, which includes working unsociable hours and Sunday work, for example, night duty, weekends, and so on.

Would the Minister of State work under such a contract? This is the elephant in the room. Private, for-profit nursing homes do not pay their staff enough. Fundamentally, they do not recognise their right to be represented by trade unions. My key request of the Minister of State, in the difficult work that she has in future, is to raise that difficult question with private nursing homes. We need an employment regulation order to be put in place. That can be done by getting trade unions to negotiate with private sector employers. We can then have a basic level of decency in pay and conditions that will lead to less turnover of staff and build a more solid future for workers and the sector. That is the only way that this can happen. Unfortunately, the biggest roadblock to that is nursing home private sector employers. That sector needs to be tackled.

I am calling for much greater supports for these nursing homes because of the crisis that we face. It has to be coupled with recognition that the workers in that sector need to have their voices represented. In the past couple of years, we heard plenty of voices from trade unions in the public sector about what workers faced during the pandemic. We never heard from a private sector trade unionist in the nursing home sector because they had not been given that voice. For me, as a trade unionist and as republican, that is a key issue that has to be tackled. I wish the Minister of State well with that task.