Timmy Dooley (Fianna Fail) | Oireachtas source

I appreciate the opportunity to speak on this matter. I welcome the Minister of State to the House and join with the Acting Chair in recognising the tremendous enthusiasm, effort and energy she has put into her brief. I know first-hand the work she does. I have seen her visit a number of facilities in the constituency of Clare, an area I know well.I have seen the way she deals with Department officials, with nursing home owners and with patients. She is universally regarded and liked by all, not only because of her warm approach but also due to her understanding of the detail and her tenacity. She is a shining example of the way that element of her Department should be led and has done sterling work. She visited Ennis some time ago when my mother was recovering from a hip operation. My mother still talks about that encounter and regularly asks how her friend Minister Mary is and I keep her updated.

There is no doubt that the nursing home care end of the health service is probably one of the most complex and difficult areas of the service. This is because it deals with people who are more often than not in the later phases of their lives and there is no easy way through. The Minister of State rightly identified that many complex cases are often dealt with in nursing homes, particularly HSE facilities. She set out very broadly the kind of operators that are there, including the community-led facilities, which are often staffed by tremendous volunteers. All the people who are involved in nursing home care are there not by choice but by necessity, often because there was no facility but there was a huge need and it grew from there. This can put an intolerable burden on the volunteers. They do not have the same economies of scale in terms of their purchasing power and they do not have the same expertise. Many of them are volunteers who come from different walks of life but the one thing they have in their core is a desire to make the lives of their patients as comfortable and as good as they possibly can and they do that to a great extent.

The family-run businesses that started as small nursing homes can struggle because of the requirements of HIQA. They may be providing care in facilities that are not necessarily fit for purpose. They are an important part of the mix, but provide a service that was acceptable 15 to 20 years ago, perhaps. They have done their best to keep up with the standards HIQA requires of them, but often the infrastructure in which they operate does not lend itself to that. There is not enough profit for them to go off and build a new facility. Then you have the larger for-profit companies without which, quite frankly, we would be in real bother. They provide a wonderful formula-driven service with great expertise and they do a very good job.

The Minister of State identified what is provided by the State under sections 38 and 39. Taken all together, it is a hybrid mix of service. It is challenging for all sides to try to have a departmental response on a universal basis. Money is the problem in all situations and it is the answer to some of it. I understand the sector and the way it will lobby. It will identify the weaknesses in some sectors and use that as a benchmark to try to create an equivalence across the service and that has to be taken into account.

There is no doubt that the service has struggled from one crisis to another. It is a fact that all of society suffered during Covid-19. These facilities struggled to keep staffing levels in place. They spent money without thinking or regard in trying to protect their patients. There is definitely pressure on some facilities as a result. We moved from that straight into the energy crisis perpetrated by Putin's war in Ukraine and the impact that has had on energy. We all jostle each other here when we reflect on how great the mild weather is, how good it is that we do not have to turn on the heating at home and how this will take some of the burden from our constituents. The few bob that is being given back in one-off grants will go further than we might have expected three months ago. However, nursing home owners cannot leave the heating off. It is on 24-7 in all these facilities. In fairness, the Minister of State has provided very significant funding to assist that transition.

There are some people in this House who do not like the fact that we live in a free market economy, but it is a fact nonetheless. Some nursing homes, because of their size and scale, are able to do better deals with energy providers. They probably have somebody in the purchasing department who has planned ahead. They are hedging by buying their energy in advance. There are others, including many of the small operations, that are struggling to keep abreast of the situation. If they are keeping in check with HIQA and keeping everything going, they may not have a member of staff available to go around and do a purchasing exercise that gives them best value for money. There is no doubt that there are people struggling in the industry. I know the Minister of State knows this. Due to their size and scale, some nursing homes are doing better than others and that is an accepted fact. The Minister of State understands more than most that there is no one-size-fits-all response. That has been the bedrock of her interaction with the sector.

I am aware from reading certain media reports that things are strained between the representative body and the Department at the minute. That is what it is. It is a feature of the jostling that goes on in lobbying and in government, which is important for keeping all of us on our toes. We have to try to get back to a point where it is more co-operative. Maybe we can do so. There are good people on all sides of this debate whose focus and intention is singularly on patient delivery. There is a role for lobbyists and people on that side. The federations involved are trying to ensure through their members that patients are well looked after. That is absolutely at the core of everything the Minister of State says and does.

I welcome the opportunity to have this debate. There are issues in the sector without a doubt. I am aware of the commitment of the Minister of State, and not just her commitment. We often talk about political commitment, journeys, outcomes in the future and visions. In fairness to the Minister of State, Deputy Butler, she has been in the job a couple of years now and my God, she has made such an impact. She has delivered. She has travelled the journey and walked the walk. She has not really been talking too much as she has been delivering on the ground and behind the scenes. I see this first-hand in my constituency. I have not said this about any Minister in the Cabinet, or anyone in the role that the Minister of State is in, but if there is one Minister or Minister of State who deserves to be retained after the reshuffle, the first one up is the Minister of State, Deputy Mary Butler.