I thank Deputy Cassells for his questions. The issue with the additional charges is that there is a disparity among different homes. They are private entities. I do not think it is within my gift to instruct them on a prescriptive method, that they should charge no more than this or no less than that or whatever else. As for the best way to deal with additional charges, the biggest bugbear for people is that they are not aware of them, that they are being snuck in or in some way added on such that people have not been aware of them and the next thing they are landed with them weekly. This was probably one of the more constructive proposals we came up with, that when the fair deal is granted to a person to put his or her loved one into a nursing home, he or she can go around and make inquiries with the different nursing homes. It does not matter. It is not like long ago, when public and private nursing homes were separate; they are all the same now such that at inquiry stage it is made abundantly clear that the cost is so much a week but there are additional charges of €100 a month. Once people are in full possession of the facts and know exactly what they will face, they do not seem to have a difficulty.
There is the difficulty that I must tread a fine line in not getting too prescriptive. I do not want to throw the baby out with the bathwater. What is really key in all this is that nursing homes put on a range of additional engaging activities. I do not want to go into nursing homes and see older people sitting on their chairs, their heads turned sideways, staring into the great abyss or out the window. None of us wants to see that. We want to see them being active, engaged, participating and so on. One can be very prescriptive with a version modelled on paper. For example, for mass on a Sunday morning the priest might get a stipend, but will only those who attend mass be charged? I have no difficulty with a universal collection for a priest to come in. Perhaps not everyone will avail of that mass. They might not be of that religion. Similarly, not everyone might like the music, the dance, the drama, the cooking or whatever else, but I want to ensure we do not set limits - in other words, that there is no disincentive. I want people to be incentivised. I have said ad nauseam that we have been very successful as a county in adding years to life but that the real challenge is to add life to those years. Nursing homes will play a key part in this, provided we work in partnership. I do not want to be heavy-handed or prescriptive. To be fair to Nursing Homes Ireland, it has been very proactive, has engaged with me extensively on this and has been very quick to write to its members to tell them this is an issue, with its suggestions as to how to resolve it, looking for openness and transparency, following guidance and so on. On this issue, I am satisfied for the most part. We are doing a bit of work on it. Mr. Karl Duff, who is here with me, is an assistant principal in the Department of Health. He and an official from the HSE are visiting a number of nursing homes and ascertaining the levels of charges. They are doing so randomly, announcing their arrival on the instruction of the Minister, telling the nursing homes they would just like to know what their situation is and what they are doing, engaging with the residents and seeing the range of activities taking place. To be fair, we are finding very good co-operation from the nursing homes sector on this as well.
On issues of capacity, nursing homes and their profitability and so on, this debate with nursing homes will always be there. They have made their case to me on numerous occasions. I am at an arm's removal because it is the NTPF that is tasked with negotiating with each nursing home and it does so individually. It is obviously commercially sensitive, commercially appropriate and commercially difficult to negotiate with each individual nursing home and look at its range of costs and an acceptable rate of payment, so the Minister of State has no role in this regard, and rightly so. I should not be dictating what any nursing home would get. I do, however, think we can do more. I am concerned that there might be an overly hands-off approach to private nursing homes because they are private. With a view to this, I have promised NHI that I would be very open to having an open forum with its members, the stakeholders from the Department, the HSE and whoever else to air any particular issues because there are things on which we could work collectively and address collaboratively. As I said, I find NHI very good on that level.
I hope that answers the Deputy's questions.
