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Dáil Éireann debate -
Thursday, 4 Apr 2019

Vol. 981 No. 5

Saincheisteanna Tráthúla - Topical Issue Debate

Childcare Services

I bring to the attention of the Minister the crisis in the not-for-profit community childcare sector. She will be aware of this issue because I have forwarded her considerable correspondence from the groups concerned not only in Carlow-Kilkenny, but also in the neighbouring counties. In addition, there is an issue in respect of Pobal investigations into childcare and audits which have taken place, but also with investigations into community care units throughout the country. Public meetings are being held. The Minister of State, Deputy Phelan, who sits at the Minister's side, attended one such meeting. The critical need for finance and funding in this area and the need for an understanding of how these services are delivered were outlined for us at this meeting. These are the most marginalised communities in the country. A childcare facility in one community has told me that it will not be able to re-register 49 children because of what Pobal said in a recent audit.

It is also true that these facilities are dealing with parents and families, some of which are dysfunctional and some of which have great difficulties. As a result of that, children may arrive late or go home early. The centre, which is usually a family resource centre, has to engage with the families and has to encourage them along the route to childcare and after-school services. That has be understood. The system must be flexible if it is to allow all of the services to be delivered. If numbers are lost in the not-for-profit sector, staff will then be lost. The sector is currently losing staff because much better pay is available in the private sector than in the not-for-profit community sector. Despite this, those in the not-for-profit sector are doing an extremely good job. They are certainly having a positive impact on the communities they serve.

They are allowing families to get out of a cycle of unemployment or, in terms of school attendance and so on, neglect.

While Pobal has a duty to audit, we as politicians, and the Minister in particular, have a duty to suggest to Pobal that there is a need for flexibility. Humanity can be a messy business and, therefore, rigid accounting rules often do not fit easily with the care and attention that family resource centres provide to children in the most deprived areas of the country.

I ask the Minister to remember that these services are being delivered at a value-for-money cost. Those being paid to deliver them are actually being underpaid per hour compared with the rate in the private sector. They do far more in the community sector than just their hours, for example, administration and dealing with the level of bureaucracy imposed on them. At the public meeting I attended, a great deal of anger arose from the fact that they had not been fully consulted. They made the point that, when establishing a Government-private sector contract, there would be negotiation, everyone would be around the table and something would result from it. In this case, all the stakeholders were not around the table. They feel particularly aggrieved about that.

Assisting families to access high-quality, affordable early learning and care, ELC, and school age childcare is a priority for me as Minister. My Department funds a number of ELC and school age capital, SAC, programmes and I want to see investment in this area continue to increase significantly in the coming years. I am delighted that First 5, the whole-of-Government strategy for babies, young children and their families, commits to doubling investment over the next ten years.

Given the large amount of public money invested in these programmes, there needs to be an appropriate level of oversight and accountability. My Department's approach to protecting Exchequer funding and ensuring compliance is balanced appropriately with the supports we provide to services to enable them to continue to deliver a sustainable and high-quality service.

Pobal, as the administrator of my Department's funded childcare programmes, conducts compliance visits to childcare service providers. These visits check a service's compliance with the published rules of Exchequer-funded programmes. Results from Pobal compliance visits for the first part of the programme year 2018-2019 show a significant level of non-compliance. This needs to be addressed as a matter of urgency. In particular, many childcare services have been found to be in breach of programme rules concerning attendance records and registrations. This issue has been especially acute among services offering the community childcare subvention, CCS. Non-compliance like the type we have seen in the CCS represents a risk to Exchequer funds, as it can lead to services receiving funding in excess of their entitlements. For this reason, my Department, working with Pobal, identifies incorrect registrations and applies the relevant corrections to ensure that services receive the correct level of funding.

I recognise fully the challenges that can be faced by community services where incorrect registrations have been discovered. That is why my Department has developed a strong case management system, operated by Pobal, through which a dedicated team assists services facing challenges. This case management system provides non-financial assistance or support in the first instance and is focused on engaging those providers with an identified overclaim. Where financial difficulties or sustainability issues arise, services can access a budget that I have created to assist with these challenges and help them in transitioning in a manageable way towards sustainability. I am encouraged that the majority of services have engaged constructively with the process so far and a way forward has been found. I recommend that all other services get in contact with Pobal or their local city or county childcare committees if they need support and advice. I want to stress that expert assistance and financial support are available to those services that need it.

The existing targeted childcare schemes will be replaced later this year with the national childcare scheme, NCS, which was developed based on evidence of the best interests of children and families. Its attendance rules will reflect the reality of children and parents' lives and the need for services to operate as businesses. My Department is engaging with service providers on the development of the NCS.

Deputies will be aware that investment in childcare has increased by an unprecedented 117% in the past four budgets and now totals €575 million per year. Community services access much of this growing investment and I note that the targeted childcare supports provided under the CCS and the training and employment childcare scheme were enhanced significantly in September 2017, some by as much as 50%. The NCS will mark another significant milestone in this type of care, creating an infrastructure in which the Government continues to invest.

The Minister has spoken in general terms about the scheme and the new one that will come on stream at the end of the year. I would be the last to suggest that the Minister should ignore an audit or not seek value for the taxpayer's money. However, it would be remiss of me not to tell her that a certain degree of common sense had be mixed into what was happening in communities at charity level. They are facing specific challenges that are different than those facing the private sector. They are trying to cope, not just with attendances, but with what is happening in the child's home. They are trying to give families support. The last thing they want is to lose a child. They want to work with the child and the family.

The audit must have a human interest element in terms of these children. A balance must be struck between auditing a book and auditing a life. That is what is going on. If everything was as rosy as the Minister said, these public meetings would not be happening and one of the projects would not be telling us that its loss-making could run to €40,000 per year due to changes being made pursuant to a Pobal audit that did not recognise the issues that would be created for families and the children attending.

SIPTU has agreed to support the staff in their efforts to get fair play for the sector and those employed therein. One man who has worked in the sector for the past 12 years has told me that he is still on the same rate but is there because he enjoys the job, likes the mix and wants to be involved in the community. I ask the Minister to go beyond her scripted reply and look deeply into the hearts of these families and young children.

I appreciate the Deputy's response. As he knows, we always prepare a script, which is what I have shared with the House. Going beyond it, I am aware of the issues. The Deputy will appreciate that I fully understand the community not-for-profit childcare sector and its challenges, having set up a number of such services myself. Those involved the sector would not want to do anything that, while not necessarily against the rules, was contrary to the ways in which they were provided support from the Exchequer. They follow those ways faithfully because they want to be as accountable and responsible as anyone in the private sector.

I understand the Deputy's remarks about there being additional needs in the context of community not-for-profits, the provision of what families require, etc. That is why there is a strong case management programme, developed by my Department and operated by Pobal, to support those services that may have demonstrated non-compliance with clear rules on how to register children. The services are checked to see whether all those children are in attendance for the hours in question over a certain period referred to as a snapshot window. If not, moneys have been paid that should not have been. What happens next is not a case of us just going in and grabbing the money back. Rather, we have established a case management system to support services in finding a way of ensuring future compliance.

Regardless of whether there are problems regarding the sustainability of that community service, there are other supports, including those of a financial nature, available. I am concerned to hear that community or public meetings are being held; I am interested in hearing more about that from the Deputy. I am also concerned that one service has indicated that it cannot re-register 49 children and another service finds that it is €40,000 down and that it has a lack of sustainability. I understand that my Department is finding ways to support those services. To my knowledge, no service has closed on foot of the compliance procedures that have been operating. Those compliance procedures and rules, as the Deputy may be aware, are shifting and changing, and the establishment of the national childcare scheme because of the consultation we have done with the sector. I would be happy to hear more about the 40 children who cannot be re-registered and the service which, it appears, either may not be sustainable or is not receiving the support it should be.

I have already written to the Minister about this matter.

Perhaps the Minister and the Deputy could have a chat.

Nursing Home Services

This is an ongoing issue. It was raised by Nursing Homes Ireland, which held a very well attended briefing in Buswells Hotel some time ago. It has followed up with meetings in the Dáil recently in order to highlight the issue. The message it is sending is that unless this issue is addressed in a timely, professional and effective way, the situation is going to worsen, with dire consequences for those in need of nursing home care. We know, from the statistics provided, that Nursing Home Ireland has over 350 nursing homes in the private and voluntary sector in the Republic, with a further 91 in Dublin. That translates into 17,000 beds and over 20,000 staff. It is also the case that 80% of long-term beds are provided through the private and voluntary sectors, with the other 20% provided by the public sector. The former are making a major contribution. The crisis began with a number of closures of smaller nursing homes.

HIQA was very complimentary about these small, homely, family-run services. The nature of service provided is high quality. It is 24-7 and professional, meets the clinical, social and dietary needs of the residents and provides activities. The services play a role in the discharge of hundreds of patients from hospital beds, which is important given the serious situation in that area. There are four areas which need to be addressed, the first of which is the charges levied. The difference between public and private in this respect is astounding. Public rates are €896 at the lowest end to €2,399 per resident per week at the higher end. In the private voluntary sector, rates are between €765 to €1,355 per week. There is an obvious discrepancy there and it must be addressed. A review of the system for setting up nursing home prices under the nursing home support scheme is awaited. A fit-for-purpose model for charges is needed. The review was due in June of 2017, yet it is still outstanding. Replies to parliamentary questions indicate that it will be released soon; perhaps the Minister of State could tell us the date in her reply. There is a discrimination within the fair deal scheme that has to be addressed. A provider informed me that they are not-for-profit organisations, but they are not for loss either.

Staffing is another issue. There is a crisis in the context of recruiting healthcare assistants. The shortage, if it persists, will lead to closures. Nursing Home Ireland is asking that the role of the healthcare assistant is removed from the ineligible category of employment permits list. New categories have been introduced to answer shortages in various crafts and trades; why can this not be done for healthcare assistants? Private and voluntary bodies are training the healthcare assistants, who are then moving on to hospitals.

There is a major issue with regard to what agencies are providing. Agencies are supposed to be for emergencies, but the rates of pay I have seen are €31.50 per hour between 8 a.m. and 2 p.m., €35 per hour between 2 p.m. and 8 p.m., €75 at night and up to €150 if there is an emergency. One can imagine the amount of money that is being spent on agency staff. I am not sure how much goes directly to the staff - I am sure some goes to the agency - but this creates a big problem. Why would anybody work in either the private or the voluntary sector? It was stated that agencies are killing the health system and they have been described as a costly disaster. In a number of nursing homes, nuns provide the services. Their work, of course, is unpaid. Nuns are an ageing breed; they are not going to be available forever, which presents another staffing issue.

Nursing homes have qualified nurses on their staff, yet those nurses are not allowed to put in intravenous drips. That should be looked at. Nurses should be able to do that in nursing homes so that patients do not have to be brought to accident and emergency.

The Minister for Health, Deputy Harris, had certain things to say about the GMS contract - I will not read out his comments - but the current contract means that access to GP services for nursing home residents is constrained. Nursing Home Ireland is calling for a new GMS contract to include specific reference to nursing home residents. This is needed now, not next month. If residents have access to GP care in the nursing home it means that they do not have to go to accident and emergency, which can be a long, difficult process, particularly for elderly people with Alzheimer's or dementia.

I am taking this question on behalf of the Minister of State at the Department of Health, Deputy Jim Daly.

The Minister of State should be appointed "Minister for Topical Issues".

I am acting in that capacity at the moment. I thank Deputy Maureen O’Sullivan for raising this issue. The Minister of State, Deputy Jim Daly, apologises for not being here.

The Government’s core stated objective is to promote care in the community so that people can continue to live with confidence, security and dignity in their own homes and communities for as long as possible. There will, however, always be a cohort of older people who require a quality long-term residential care option. The nursing homes support scheme provides financial support for those in need of long-term nursing home care. Participants in the scheme contribute to the cost of their care according to their means while the State pays the balance of the cost. The aim of the scheme is to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.

The review of the nursing homes support scheme, NHSS, published in 2015, identified a number of issues for more detailed consideration, including a review of the pricing mechanism used by the National Treatment Purchase Fund, NTPF, with a view to ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers; increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions us possible; and ensuring that there is adequate residential capacity for those residents with more complex needs. A steering group was established to oversee and manage the pricing review. The steering group is chaired by the NTPF and includes representatives from the Departments of Health and Public Expenditure and Reform. As part of its work on the review, the NTPF sought various inputs including external expertise and stakeholder engagement to inform the review. These inputs are being considered in detail.

This report is significantly overdue, however. I understand that the NTPF is close to completing the report and it is expected that the steering group will be provided with a final draft very shortly. Once complete, the report of the review will then be submitted to the Department of Health. It is recognised that any change to any part of the scheme must be considered in terms of the short and long-term impact on the viability of the scheme and accessibility of long-term residential care in general. It is important, therefore, that the relevant issues are considered thoroughly through this review process and that we ensure that support for people who require it remains on a sustainable footing.

The nursing home sector has also raised concerns in relation to staffing, particularly in terms of securing access to appropriately qualified staff. On foot of these concerns, nursing home providers have requested the removal of healthcare assistants from the ineligible list for permits issued by the Department of Business, Enterprise and Innovation to bring in workers from outside of the European Economic Area, EEA. These permits may be issued for occupations in respect of which there are labour or skills shortages. The results of the most recent review of the employment permits critical skills list and ineligible lists of occupations that come into effect on 22 April 2019, as set out on the website of the Department of Business, Enterprise and Innovation, contain no changes to the grades of care worker arid healthcare assistants.

There needs to be a clear demonstration that recruitment difficulties are solely due to shortages and not to other factors, such as salary or working conditions.

Both Departments met sectoral representatives and considered their business case. The sector has been advised that more evidence is required of the labour shortage and that they must demonstrate full engagement with the Department of Employment Affairs and Social Protection. On provision of this evidence, the matter will then be reconsidered. The Minister of State, Deputy Jim Daly, acknowledges the significant role of private and voluntary providers in residential care provision. I assure the House that he and the Department will continue to engage with the nursing home sector.

There is a danger of shooting the messenger because I must acknowledge that reply was very disappointing. To go back to the review and how long it is taking, it is acknowledged that it is significantly overdue but we are not too sure why it is taking so long. The report is close to completion but we still do not have a date as to when the review will be available.

What must also be considered is that we need a system whereby when a satisfactory rate is struck, it will be proofed against inflation in relevant areas of cost for a number of years. We hope inflation will decrease as well as increase but that proofing must be included also. There are concerns about the appeals mechanism and this needs particular consideration. With regard to the price review, is there professional and independent costing and other technical and relevant expertise?

In the context of staffing, the Minister of State's reply stated it must be proved there is a genuine labour shortage and it is not due to other factors. I have given the facts about the work and the rate that can be paid when going through an agency. How can agencies offer so much when the funding is from the State? This is leading to shortages in the private and voluntary sector. Somebody has to join up the dots and look at the matter in a much more holistic way. Earlier, I spoke to my colleague, Deputy Pringle, and he told me there is a very good system in Donegal where there is close co-operation between hospitals and community nursing homes but there is a fear this could be subject to change.

The voluntary and private sectors are providing much-needed care for long-term residents in particular. We must acknowledge that there is an increasing demand for the service. We want to keep people in the community but it will not be possible for everybody. Further closures will have serious consequences so these issues must be addressed. I could not get over the difference between the average public and private rates, which ranges from a difference of 40% to 163%. This needs to be looked at as well as the other issues I have raised.

I do not have a closing statement on this. I acknowledge Deputy Maureen O'Sullivan's frustration, particularly with regard to the report that is significantly overdue. I would like to revert to the Minister of State, Deputy Jim Daly, on some of the questions the Deputy has raised and ask for a more specific response. I am not in a position to give Deputy O'Sullivan specific answers. I hope she will bear with me while I raise the issues with the Minister of State, Deputy Jim Daly, and ask him to respond. I acknowledge Deputy Maureen O'Sullivan's frustration about the clear fact that I am not in a position to answer some of the questions she has asked. I will go to the Minister of State and ask him to provide specific answers.

A Cheann Comhairle, I have been asked to take the next matter but I do not have a script. It was not brought; I just received a short note.

That is not fair to the Minister of State or to the Deputy who tabled the matter.

Or the seriousness of the matter to be addressed.

The script is being delivered now. I have not seen it. I am not sure whether I will be able to take the matter. Perhaps the Deputy would like to defer.

We can defer until Tuesday if Deputy Ó Caoláin wishes.

I am only receiving the reply now. I apologise.

This is very unsatisfactory. I responded to the opportunity. In respect of the Minister of State, Deputy Byrne, who has not even had sight of the reply and has just been handed it-----

It is not the fault of the Minister of State, Deputy Catherine Byrne.

No, I acknowledge that absolutely.

I only just got it.

If the Deputy so wishes, we will take the matter again. If the Deputy resubmits the matter, it will be selected as a priority on Tuesday.

"Priority" is the key word. I accept the suggestion of the Ceann Comhairle. I hope the Minister for Justice and Equality will present himself to address the issue involved.

Whoever might attend, I have to say it is most unsatisfactory to find ourselves in a situation whereby we have only been able to proceed with two of the four Topical Issues selected. This is becoming something of a habit. I am afraid that we cannot lay responsibility entirely at the door of the Government because frequently people who submit Topical Issues then withdraw them as soon as they have been selected. That is not acceptable either.

I have the response if Deputy Ó Caoláin would like to read it.

No, he wants to be able to engage with the Minister directly.

It would be appropriate to engage directly with the Minister for Justice and Equality.

I apologise to the Deputy and the Ceann Comhairle. I have only just received the reply.

I do not think either of us hold the Minister of State in any fault.

We will suspend for ten minutes while we prepare to take the next item and give the participants of that debate an opportunity to prepare and arrive.

Sitting suspended at 3.55 p.m. and resumed at 4.05 p.m.