Mary Butler (Waterford, Fianna Fail)
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As Minister for Mental Health and Older People, I welcome the ESRI report: Long-term Residential Care in Ireland: Developments since the onset of the Covid-19 pandemic. The report brings into focus the challenges facing the long-term residential care sector in Ireland which the Government continues to address to provide short-term stability and long-term growth to this sector.

Long-term residential care is provided by the private, voluntary (not-for-profit) and public (HSE) sectors. The Government subsidises nursing home care for older people through the Nursing Home Support Scheme (Fair Deal). Some other types of residential care for older people are also supported through Section 39 grant agreements.

Year-on-year funding for the Nursing Homes Support Scheme continues and will reach €1.5 billion this year. Nursing homes that renegotiated their Deed of Agreement with the National Treatment Purchase Fund (NTPF) in 2023 are seeing an average uplift of 6-7%.

The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic. Over €151 million of financial support was provided to private and voluntary nursing homes through the Covid-19 Temporary Assistance Payment Scheme (TAPS). The provision of free PPE and oxygen to private nursing homes continues, costing approximately €77 million to date. A €10 million scheme (TIPS) was established to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home. This scheme was extended for a second time to the end of June 2023.

A new €10 million scheme has also been established for 2024, designed to target and support structural improvements in nursing homes to assist with meeting HIQA compliance obligations in respect of protection against infection and fire precautions. This scheme is active from 1 January 2024 and can be backdated for eligible works to 1 January 2020.

Long-term residential care is a crucial part of the overall continuum of care and public Community Nursing Units (CNU) play a vital role in the provision of long-term care across the country. The Government is committed to continued investment in healthcare infrastructure which supports the highest quality care for our older population and provides equitable access to this care in every region.

This investment includes the CNU programme, which was launched to ensure that up to 90 of our public Community Nursing Units would be refurbished or replaced to ensure the best quality environments for our older people. As of Q3 2023, 47 projects have reached construction completion. Construction is under way on several more facilities, while the remainder are at various stages of review, appraisal, design, and tender.

In Q4 2022, I announced the awarding of the contract to deliver 7 CNU’s through Public Private Partnership (PPP). The CNU PPP Project will deliver 530 beds in total, comprising both short and long stay beds for older persons at seven CNU facilities across the country.

A clear indication of the Government’s desire to plan appropriately for the future, in the context of an ageing population, is the update of the 2018 Health Service Capacity Review, which is currently being progressed. This is particularly important given changes in the health and wider operating environment since the original 2018 review was undertaken. This work will forecast future capacity requirements in acute care, primary care, and in social care services for older persons (residential and homecare services) up to 2040.

Government has also approved the creation of Regional Health Areas, requiring significant restructuring of health and social care organisation in Ireland, underpinned by regional population-based planning and resource allocation models. A national framework for health and social care capacity planning, creating the tools and infrastructure to support consistent, data driven, regional planning will be a critical success factor for this work.

High-quality design, planning, and construction is vital in creating safe environments that enable high quality residential care for older people. I have therefore committed to creating new design standards for long-term residential care settings for older people (public, private, and voluntary).

On the 19 December 2023, I announced a public consultation on a Design Guide for Long-Term Residential Care Settings for Older People. The Department of Health, in conjunction with the Health Service Executive (HSE) and the Health Information and Quality Authority (HIQA), is currently seeking the views of the public on a draft Design Guide for Long-Term Residential Care Settings for Older People and the feedback received will inform the final version of the design guide.

It is acknowledged that the nursing home sector has evolved over the last 30 years from a predominantly State led service to a situation today where approximately 80% of nursing home services are provided by the private sector. I am aware of the investment trends in the Irish residential care market, the growing consolidation of the sector, and the complex investment and ownership structures that now exist. I am also aware of the potential risks and unintended consequences associated with the level of care services currently being provided by the private sector. It is therefore important that all aspects of the nursing home sector are scrutinised over the coming years, and I am committed to ensuring that service delivery and configuration in the sector meet the needs of service users in a sustainable and safe manner.