Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank all the Members who contributed. I am looking forward to being able to respond on some of the issues raised. It is a great opportunity to be able to come into the House. I always find that the contributions are balanced and measured. They differ, but at the same time this is a great opportunity. I wish to clear up some points because I do not agree with everything said regarding the private nursing home sector. I am making every effort to support reform in and to improve our nursing home homes to ensure everyone who needs residential care enjoys a good quality of life. The one thing we must remember in this regard is that nursing homes, whether they are public, private or voluntary, are our loved ones' home from home. This is more than likely where they will end their day and must be acknowledged.

Fair deal is the budget I will get from 1 January 2023 to 31 December 2023. It is my job to ensure that budget will be sufficient to look after the 22,500 people who live in nursing homes next year and that it does not run out. Some of the Members might remember that a few years ago this budget did run out and people were waiting for up to 12 weeks to get into a nursing home. I will not allow this to happen. The turnover from a successful fair deal application to entering a nursing home is four weeks. I have kept this time steady for the past two years.

The private nursing home sector is very different. For example, €2.3 billion has been invested in the private nursing home sector by European investors since 2020. In August 2022, Bartra Healthcare sold four nursing homes to a Belgian real estate investment trust, REIT, in a deal worth €161 million. On one side of the equation then, we have the nursing home sector being seen as a viable process for some investors, while on the other side we have the voluntary and small, family-run nursing homes that are struggling. It is a complicated issue.

Senator Martin quoted a comment suggesting there was little recognition by the State. I must say I am disappointed in this. I know that it was not the Senator's comment but something said to him. A total of €145 million was allocated through the temporary assistance payment system, TAPS, in the past two years. This is still ongoing for any Covid-19 outbreaks. Some €67 million was provided in personal protective equipment, PPE, and oxygen supplies in the past two years, and this is also ongoing. Last week, the Minister, Deputy Stephen Donnelly, and I announced funding of €10 million, backdated to 1 July 2022 and running until the end of this year, to support inflationary costs. We will review this aspect again. The private nursing home sector was paid €1 billion in fees last year. If this is little recognition from the State, then I am at a loss. One-twentieth of the health budget was paid to 22,500 nursing homes last year. I just want to make those points.

Senator Mullen also referred to the value-for-money report. It is possible to look at reports and pick the bits we like. I am therefore going to pick the bits I like. The value-for-money report clearly shows that there is a higher level of staffing in public nursing homes, with a higher nurse to health care assistant ratio. The conclusions of the value-for-money report referred to by Nursing Homes Ireland relate to an examination of a small sample of five nursing homes. The report itself cautioned against relying on those results. We can, therefore, take different parts of the report and decide which piece might suit us the best.

To return to what I said at the start, there has been much talk of discrimination between public and private nursing homes. Last year, 4,500 residents were in HSE-run community nursing units. The HSE will always step in where residents' needs are sufficiently complex that they are not able to be cared for elsewhere in the community. The HSE needs to be staffed to deliver this type of complex care. This is a fact. I have spoken to people in the community nursing units and visited them. I have also spoken to the head of the older persons' section in the HSE. I was interviewed on the radio last week and I had only just come off when I got a text from someone managing one of the community nursing units saying it has residents that go into hospital from a nursing home but, unfortunately, those patients deteriorate and then they go to the community nursing units. This is because of the standard of nursing supports available to support them.

I agreed with a great deal of what Senator Gavan said. Planned sectorial reforms must happen. I am not one bit happy that I inherited a situation where 80% of nursing homes are private. There should be much more public provision. One of the things I am working on now is a new funding stream for nursing homes that are dementia-specific. Like Carebright in Bruff in County Limerick, which I visited, and St. Josephs in Shankill, 70% of people in nursing homes may have a diagnosis of dementia or be showing signs of dementia. This is a huge number. We certainly need dementia-specific facilities across every CHO. There are currently two streams in the fair deal scheme, the public and the private. I am putting a stream in the middle of those which is only for dementia-specific places to support people to come into the community. Many have looked at the situation in Carebright in Bruff but felt it was not financially viable. I want to make it financially viable to support people and to have these dementia-specific places. This is important.