Deputy Dillon wants to discuss the importance of the multi-annual rural water programme, which is very important in County Mayo.
Saincheisteanna Tráthúla - Topical Issue Debate
Water Services
It is important and I express my gratitude to the Ceann Comhairle for selecting this Topical Issue matter as it holds significant importance in Mayo.
The multi-annual rural water programme is a crucial initiative that focuses on improving water quality in rural areas and ensuring access to clean and reliable drinking water for rural communities. Looking ahead to the future, the multi-annual rural water programme for the period 2023 to 2025 is anticipated to bring substantial benefits to Mayo, especially through the provision of new water connections. This will enhance access to clean water, elevate quality of life, foster economic development and promote sustainable growth in our communities. However, in specific areas of north Mayo approximately 500 households are still without running water. I am not sure whether there are issues around access to running water in counties Kildare or Wexford.
Since entering the House, I have consistently raised this matter, sought updates on the timing of new water connections and emphasised the importance of providing access to clean and reliable water for communities. Communities such as Carrowteige, Shrataggle, Portacloy, Porturlin and Clery in Kiltimagh are currently living without piped water supply. The water is frequently condemned, rendering it undrinkable and unusable. Residents urgently require a new community water connection. Households are facing dire circumstances that is severely impacting on their quality of life and living standards. They struggle to reach adequate home heating temperatures, are unable to shower and face difficulties using their washing machines and dishwashers due to clogging of systems caused by bog water. It is disheartening to think that in 2023 households in certain areas of County Mayo still lack the fundamental necessity of running water. Last July, the Minister for Housing, Local Government and Heritage stated that the Department expected to announce programme priorities and invite local authority submissions or bids by late 2022. It is May 2023 and no progress has been made on this matter. Will the Minister of State provide some clarification on future iterations of the rural water programme? What is causing the delay in the current programme and when can we expect an announcement on the next programme? I thank him for his attention.
I thank the Deputy for raising this important issue and providing me with the opportunity to address the matter on behalf of the Minister.
I confirm that the Department’s multi-annual rural water programme, through Exchequer funding, delivers improvements to water services in areas of rural Ireland where there are no public water services. The programme provides capital funding aimed at improving the quality, reliability and efficiency of rural water services infrastructure. The bulk of funding is spent on the improvement of water quality in group water schemes and individual wells, with more limited funding provided for group sewerage schemes and domestic wastewater treatment systems, mostly septic tanks. The day-to-day administration of the multi-annual programme is devolved to the local authorities. To date under the current multi-annual programme, more than €74 million has been provided to fund projects. Local authorities have recouped almost €36 million from the Department for these projects to date. More than half of the 700 individual projects allocated funding under the programme are completed to date.
In respect of the new multi-annual rural water programme, the Department is currently working to finalise the framework documentation. A steering group, the rural water working group, is tasked with overseeing the launch and management of the programme. The work required to finalise the composition of the specific measures in the programme will be completed shortly and a report will be sent to the Minister. When he has had an opportunity to consider the report, I expect he will announce details of the programme and its priorities. Local authorities will then be invited to submit applications for funding for priority projects in their areas. An expert panel will then critically evaluate all applications and a report will be submitted to the Minister for consideration and approval later this year. All local authorities have been advised to engage with groups in their functional areas to prepare requests for funding for the upcoming programme, while continuing to manage the current programme. In April 2022, funding for a new €50 million measure, an advanced element under the multi-annual rural water programme for the wastewater collection and treatment needs of villages and settlements without access to public wastewater services was announced. Local authorities have submitted priority applications for funding under this scheme. Each application has been evaluated by an independent expert panel and funding for specific projects will be announced shortly.
Funding is provided on a multi-annual three-year cycle to provide funding certainty to the rural water sector, which allows the programme to meet the emerging demands and increases effective planning. The multi-annual approach also helps to address environmental and public health compliance in the existing group water schemes; incorporates mechanisms to protect, maintain and enhance rural water assets; and establishes a structure to fund new group water schemes into the future. Capital expenditure under the multi-annual rural water programme was €20.76 million in 2022. The €35 million allocated for 2023 contains €10 million for the new measure for the wastewater needs of rural villages without access to public wastewater services. The programme is consumer focused and achieves its aims by helping group water schemes to achieve wholesome, clean drinking water that is safe to drink on a consistent long-term basis by complying with the drinking water regulations. Leakage control is also funded through water conservation and supporting good practices which contributes to reduced costs for energy and consumables. The expansion of piped water supplies and central wastewater collection systems is also facilitated. Funding innovation and research to improve the efficiency of the rural water sector is also supported. The Department is committed to delivering improvements to water services in areas of rural Ireland where there are no public water services.
I appreciate that the Minister of State is filling in for the Minister responsible for this area and I appreciate the response he read out.
From discussions with Mayo County Council, I understand that both the local authority and many group water schemes are ready and waiting to act on requests for submissions for new water connections. The Minister of State outlined the additional €50 million measure for wastewater collection and treatment needs but the priority in this discussion is new connections. The lack of communication regarding a submission process framework to fund bids for the new four-year cycle has been disappointing. The disappointment of people in north Mayo every time they ring our constituency office is heartbreaking. Many of the residents in Carrowteige have received pre-connection permission from Irish Water. Their proposal was submitted and reviewed and it was deemed feasible so the next stage of the process is where the real bottleneck is. Everyone is in agreement that the programme is of vital importance to householders and rural Ireland. Everyone should have an entitlement to clean running water.
I will make an additional point to the Department on the grant aid per household. I ask that the Minister review the connection fee of €9,000 per household and also waive the Irish Water connection charges, which are over €2,200, in light of the current rate of inflation in the costs of materials etc., so that we can deliver these schemes on the ground. I ask that the Minister bring forward the report, take on board its recommendations and instruct all local authorities to make their submissions in a swift manner.
I thank Deputy Dillon again for raising this important matter. On the multi-annual rural water programme, as I indicated, to date, allocations of just over €74 million have been provided nationally and just under €36 million has been recouped by local authorities. Mayo County Council was allocated over €25 million, of which, to date, just over €8 million has been recouped. There are more than 50 individual projects of various sizes, some large, currently being managed by Mayo County Council that have yet to be completed. The funding provided under the multi-annual programme sets out how we can best achieve optimum outcomes to advance the needs and expectations on rural wastewater. As I said, an expert panel will critically evaluate all applications and a report will be submitted to the Minister for consideration and approval later this year. I thank the Deputy again for raising this matter. I will bring his concerns to the Minister's attention.
Work Permits
In the next Topical Issue debate, Deputies Joan Collins and Mick Barry will discuss the situation facing a group of nurses, mainly from India, who are working as healthcare assistants under a work permit scheme.
I thank the Ceann Comhairle for selecting this Topical Issue matter. I am raising this issue on behalf of Migrant Nurses Ireland, which explained its members' plight at a presentation in the audiovisual room two weeks ago. The meeting was organised by Deputy Barry.
The issue of recruitment and retention remains a huge problem for the HSE. The Joint Committee on Autism discussed it as recently as today. As part of an international recruitment campaign, through the Department of Enterprise, Trade and Employment, the HSE introduced the general work employment permit scheme for care assistants from non-EU countries. At the time, it was agreed with the Department of Health that the minimum salary would be €27,000 per annum. There are approximately 3,000 people on the permit now. As part of the scheme, these workers are obliged to undertake a Quality and Qualifications Ireland, QQI, level 5 course for the role of healthcare assistant. This is despite the fact that many of the Indians on the scheme are qualified nurses whose qualification allows them to register as nurses with the Nursing and Midwifery Board of Ireland, NMBI, after a language test and adaptation course to the Irish health system. It is a bit mad that they are working as healthcare assistants even though they have that qualification.
The QQI courses cost up to €1,700 and the workers cover that expense. Will the State negotiate changing the conditions to allow these workers to be recognised and become healthcare assistant carers on the basis of their nursing qualifications and completion of an English language test and adaptation course for the Irish health system? It seems crazy that these nurses are overqualified. They have been kept in a low-pay and family reunification exclusion trap because they are mainly in the private sector earning €27,000 as a starting rate. The income threshold to qualify to bring over a spouse is €30,000 per annum, which puts them in a real quandary.
I call Deputy Barry. I nearly called him Minister Barry. The Deputy will be upset by that.
It is only a matter of time and it will be in a socialist government but that is another matter. The Minister of State, Deputy Butler, has responsibility for mental health and yet-----
It is the Minister of State, Deputy James Browne, who is dealing with this matter.
The Minister of State with responsibility for mental health is here and the Government’s policy is putting these Indian nurses through a mental health ringer. Deputy Joan Collins mentioned that there were 3,000, mainly Indian, nurses working here as healthcare assistants. Some 1,000 came over at the start of the year on two-year work permits. They are working in private nursing homes as healthcare assistants doing vital work for our health service. This is difficult and mentally draining work. The policy of the Government means they are forced to do this work while being separated from their partners and children. It is a forceful separation because the arrangement stipulates that their pay has to be €27,000. The Minister of State may say the private nursing homes can top up the money but he knows that will not happen. They are getting €27,000 per year, yet for a family reunification visa, the minimum that will even be considered is a salary of €30,000 per year. The Government is forcing these workers to do this extremely difficult work while being separated from their partners and children. It is difficult to even make a phone call and reconnect when India is four and a half hours ahead of Ireland. If someone finishes work at 7 p.m. or 8 p.m., how will they make a phone call home to the kids?
There are two ways in which the Government can deal with this issue. There should not be a threshold but the threshold could also be reduced to €27,000 to allow for family reunification or the pay could be increased to over €30,000. In the public sector and the HSE the pay is nearly €32,000. That is the road that should be taken. What say the Minister of State on that?
Notwithstanding the points the Deputies make, we can all agree that Indian professional healthcare workers are making a huge contribution to the Irish healthcare service and that without them, we would be in serious difficulty.
I thank the Deputies for raising this important matter. Ireland’s employment permits system is designed to accommodate the arrival of non-EEA nationals to fill skills and labour gaps for the benefit of our economy in the short to medium term. This objective must be balanced by the need to ensure there are no suitably qualified Irish or EEA nationals available to undertake the work and that the shortage is a genuine one. The system is managed through the operation of the critical skills and ineligible occupations lists, which determine employments that are either in high demand or are ineligible for an employment permit where it is evidenced that there is more than sufficient availability of those skills in the domestic and EEA labour market. In order to ensure the employment permits system is aligned with current labour market intelligence, these lists undergo regular evidence-based review guided by relevant research, a public and stakeholder consultation, the views of the economic migration interdepartmental group and relevant policy Departments, in this case the Department of Health.
Access to the general employment permit, GEP, for the role of healthcare assistant was announced in June 2021 to address skills and labour shortages in the healthcare and nursing home sector. Increases in the ageing population and consequent increases in demand for services mean a significant number of healthcare assistants is required to provide sufficient long-term residential care for older people into the future. The GEP is used by the State to attract third country nationals in occupations with remuneration thresholds of generally €30,000 and is subject to a labour market needs test, demonstrating that the employer was unable to fill the position from the Irish and EEA labour market.
This policy also fulfils our obligations under the community preference principles of membership of the EU. Holders of general employment permits are eligible to apply to the Minister for Justice for family reunification permissions after a period of one year. The conditions governing family reunification, including the remuneration levels required to apply, are a matter for the Department of Justice.
I was not expecting that answer. I thought there would be some sort of clarity about how the HSE will resolve the issues these workers are facing. The point that Deputy Barry made is quite correct. When these nurses finish at 8 o'clock in the evening, they cannot ring their children up because it is 1.30 a.m. in India, and when they finish an early morning shift at 8 o'clock, their children are in school. In many ways, they can only contact their children at the weekends. Yet, they must be earning €30,000 per annum to bring a spouse home, and if they want to bring a child home it is an extra €3,000 per child. That means that for those who have one child or two children, it could be €36,000. By virtue of the policy of the Government, the €27,000 minimum income requirement per annum excludes those workers from having any opportunity to bring their spouse or children over. They have been separated from them for nearly two years. The fact that they have to pay €1,700 for the QQI level 5 healthcare assistant qualification, when they are qualified nurses already, seems a bit mad. We want to keep these workers here. They are in a poverty trap and a family reunification trap.
The Indian nurses work here as healthcare assistants in private nursing homes for two years. At the end of the two years, they have to do the QQI level 5 qualification. That takes another eight months. These are nurses. They are qualified way above QQI level 5. They have already done that, and way more, so why force them to jump through that particular hoop? Then, to add insult to injury, the Government is asking them to pay for it out of their own pocket. They are already to the pin of their collar with the rents in this country, and then they are being asked to pay, out of their own pocket, for a qualification that they already have the equivalent of and more. It can cost €1,700 for the QQI level 5 qualification.
The Government has two options here, in my opinion. The first is that it waives the demand, and I think that is the preferred option of the nurses. It should be waived. However, if the Government is not prepared to do that, the State should at least have the decency to fund those courses rather than force the nurses, who are giving blood, sweat and tears in providing a vital service, to dig into their own pockets.
The framework around access to employment permits for this role, as agreed with the Department of Health, includes the requirement for the employment to offer a remuneration level of €27,000 or more, and for the permit holder to achieve a relevant level 5 QQI qualification after two years' employment in the State. The level 5 qualification after two years' employment is the minimum required for this role. The requirement was put in place to ensure all workers in the healthcare assistant role will develop their skills in a range of qualifications, and ensure a similar standard of learning will be met and delivered in the care of vulnerable patients across care settings.
The Minister of State is reading a speech. He should reply to the points that have been put to him.
Please, Deputy Barry.
I think so as well.
This question is for the Department of Enterprise, Trade and Employment. I am answering on behalf of that Department.
You are not answering the questions that the Indian nurses are asking.
I am answering on behalf of the Department of Enterprise, Trade and Employment.
Deputy, if you do not let the Minister of State finish, it will be the end of the matter.
The framework for the HCA provision intended that education and training needs be provided by employers, with employees to be given access to funded educational programmes to gain the required level of qualifications as part of paid employment. Given the mix of public, private and voluntary providers in the nursing home sector, it is important to ensure that there is a common validated framework of minimum standards, clinical career pathways and qualifications for staff. The Covid-19 nursing homes expert panel review recommended that all healthcare assistants should have a relevant QQI level 5 qualification or be working towards achieving it. It should be noted that under the Government's Skills to Advance initiative, the level 5 qualifications in healthcare, including the level 5 healthcare support and level 5 health service skills qualifications, are available to employers and employees within the private nursing home sector to achieve the required standard under the new framework at no cost or a low cost.
I ask the Minister to arrange to meet these workers, find out what the issues are and try to resolve them.
The Deputy can talk to the Minister offline. This is not the Minister of State's baby, as it were, at the end of the day. I ask the Deputy to approach the relevant Minister. If she needs assistance, my office will help.
Okay. Thank you, a Cheann Comhairle.
Nursing Homes
At the heart of this matter are 73 families who are extremely worried at this point in time. They do not know what the future holds for their loved ones. They do not know how they can possibly afford to pay for their care at Beaumont Residential Care without the fair deal scheme and they do not know where else they can find a place in a nursing home. As the Minister of State is aware, as it stands, Beaumont Residential Care is due to come out of the fair deal scheme in less than ten days, on 31 May, in about a week. Since that announcement was made, the reaction from the families of residents has been one of huge concern. The residents are overwhelmingly elderly and very often vulnerable. Several of them have dementia. The possibility of having to find another care home would be enormously disruptive. There is a huge shortage of care homes in the Cork area. For many of them, it is very difficult to find places. If we put that into context, we have a situation where there is enormous overcrowding in our hospitals. People trying to get discharged from hospital have very few places to go. To lose 73 beds from the care system in Cork would be enormously challenging for the system as a whole.
The key priority here is the 73 families who are affected. They have told me that they are very frustrated at what has happened since the announcement. CareChoice operates the nursing home. Its side of events is that there has been a serious lack of engagement from the National Treatment Purchase Fund, NTPF, and the HSE. CareChoice wishes to resolve the situation but the HSE and the NTPF have not engaged with it and have not been actively seeking to find a solution in this regard. Were I to design a system of care for the elderly and vulnerable, it would not be the system we have. It would not be so heavily reliant on the private sector. It is not the optimum model but it is the system we have. While it is the system we have, we need to ensure that a reasonable subvention is paid to the care homes providing this care.
I accept that the Government needs to establish value for money. I ask that the HSE and the NTPF come back to the table with CareChoice. I am not saying they have to agree with everything that is put on the table. I understand that value for money has to be achieved for the public purse but they should at least engage. At this time, the sense from residents is that they have not been offered any support by the NTPF or the HSE and they have not been offered a way of resolving things. For what it is worth, in my own attempts to raise the issue and to be fair to the HSE locally, it forwarded on correspondence that I sent to the relevant people. I contacted the NTPF and when I asked for an email address, I was told there was no email address. It has not been very easy for me, as a public representative, to make my views known to the relevant organisation. I have submitted parliamentary questions and I am raising this matter with the Minister of State. I hope that she has more success in trying to chase this up with the NTPF.
The key thing here is the families. I understand that there has been a bit of back and forth between the HSE and CareChoice and all that. However, the key thing here is that these families and the residents, most of all, are supported and kept in place and that we find a solution. Can the Minister of State offer me, the residents and their relatives any positive news or encouragement as to how we might get a resolution in the tight timeframe we have?
I thank the Deputy for raising this issue. The nursing homes support scheme, NHSS, commonly referred to as fair deal, is a system of financial support for people who require long-term residential care. It was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families.
Funding to support people to access services in the sector continues to be provided in line with the long-established statutory mechanisms under the Nursing Homes Support Scheme Act 2009.
This is the mechanism established by the Oireachtas at that time to provide for the processes relating to funding under the NHSS and the negotiation of prices for services for private and voluntary providers with the designated State agency, the NTPF. Accordingly, the NTPF does not discuss publicly the details of negotiations with individual nursing homes. That is the first point I have to make. Neither Ministers nor the Department of Health have a role in price negotiations with individual nursing homes, as determined by the legislation set out in 2009.
More than 425 private and voluntary nursing homes currently negotiate their deed of agreement to agree the price they can charge for a fair deal resident under the NHSS directly with the NTPF. Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria, such as costs reasonably incurred by the nursing home, local market prices, historical prices and overall budgetary capacity. Anyone who has had a scheduled renegotiation of their deed of agreement this year with the NTPF has seen a significant uplift.
To be very clear, Government funding for fair deal is to support vulnerable older people, to whom the Deputy referred, at a time in their lives when full-time care is essential. This is a very difficult decision for families and their loved ones, and it is often made at a time of crisis. That is why it is essential that I, as Minister with responsibility for older people, ensure that the budget for fair deal, which is a substantial €1.5 billion allocation this year, will last from 1 January to 31 December for all who need it. When nursing homes are intending to close or cease participating in the nursing home support scheme, residents and their families must be consulted and given appropriate notice so that new homes can be found and they can be moved in a safe, planned way.
I need to be very clear here. There is no other mechanism for funding from the public purse for nursing home residents outside the nursing home support scheme. The Deputy said there had not been much engagement with the HSE. The HSE does not have a role with regard to the funding.
Or the NTPF.
I encourage continued engagement between the nursing home providers and the NTPF to try to resolve this issue. I really mean that. Primary responsibility for the provision of safe care and services to residents in long-term residential care facilities rests with each individual care provider. The 2013 regulations set out clear obligations on a registered provider to agree in writing with a resident the terms upon which the resident resides in the designated centre, the services to be provided and the costs involved. It is imperative that nursing homes manage potential cost pressures in line with their regulatory and contractual responsibilities, maintaining the quality of care so that residents’ lived experience and comfort are not affected. Many of the families have contacted me. I know the upset this has caused for the residents, for whom it is their home from home, and the families involved. The only way forward is for consultation. If a nursing home wishes to remain as an NTPF nursing home, it must engage with the NTPF. There is no other funding mechanism available to nursing homes outside of that scheme.
I will raise a few issues. I appreciate that people have been in contact with the Minister, and I hope she has responded and given them whatever reassurance she can. Nobody is looking for a new mechanism. I am not seeking to negotiate this with the Minister of State in the Chamber; I know that is not realistic or the way things work.
As I understand it, the way this works is that the NTPF negotiates directly with nursing homes and that the arrangements are not necessarily the same with each individual nursing home or operator but are made on a case-by-case basis. A negotiation would have occurred in this case. I also know that the uplift that has been offered to CareChoice, which has been publicly disclosed so I am not saying anything new, is approximately €16 per resident compared with approximately €183 in some other publicly run centres. While I accept that the cost basis is different, I do not expect it accounts for that level of discrepancy. I understand CareChoice is open to renegotiation and further discussion with the NTPF. It seems, however, that the NTPF is not coming back to CareChoice and is not willing to find solutions. Nobody is looking for a new mechanism. Negotiations leading to a fair outcome are being sought, which is reasonable. I appreciate that the Minister cannot get into the nitty-gritty of any contract and that there are lengthy and substantial documents involved. I ask her to indicate that when she leaves this Chamber, although it can wait until tomorrow, she will pick up the telephone to the NTPF and ask its representatives to sit down with CareChoice. Will she do that for me? Will she please contact the NTPF?
I spoke with representatives from the NTPF last week and speak to them regularly. I cannot advocate for one particular nursing home but what I did this year was-----
I am not asking the Minister of State to advocate but to ask the NTPF to come back to the table.
What I did this year was put €41 extra into the NTPF to support nursing homes. I also provided an additional €10 million on 1 July last year for the temporary inflation payment scheme, TIPS, which is still available. Each nursing home can claim up to €5,250 per month towards its inflationary costs for heating the home. Private nursing homes and voluntary nursing homes continue to receive free personal protective equipment, PPE, which started during Covid-19. This has cost the State to date between €75 million and €78 million. We continue to provide that but we have to look at this matter in the round. I have to be very clear that the NTPF is an independent statutory body. Neither I nor the Minister can get involved in any independent case-by-case funding decisions.
My understanding is that when the NTPF engages with any particular nursing home, a final price is offered and once the final price is offered, whichever home it is, and I can only speak in general, can appeal that decision. I do not agree with the figures the Deputy mentioned because they are not the figures of which I am aware. The best way forward because it is the only way to fund any nursing home that wants to be part of fair deal is through discussion. That is a very important position for older people because the more people have, the more they pay and the less they have, the less they pay, which means nursing home care is affordable to everyone. The only way to resolve this is for the nursing home provider and NTPF to talk. I know for a fact that the NTPF reached out to the home in question late last week.
Care Services
Go raibh míle maith agat, a Cheann Chomhairle, as ucht an ábhair seo a roghnú. Tá sé práinneach agus tá sé tábhachtach. Faraor géar, tá orm an cheist seo a ardú arís agus arís. In ainneoin na ngeallúintí sollúnta a tugadh dom go mbeadh an t-ionad lae seo oscailte, níl sé oscailte fós. Tá sé dúnta anois ó 2020. Bhí fadhbanna roimhe sin. Bhí an córas ar an eolas go raibh fadhbanna ó thaobh easpa foirne. Tháinig Covid-19 agus tuigim go raibh deacrachtaí ann ina thaobh ach ní thuigim cad atá tarlaithe ó shin. In ainneoin go bhfuil sé ráite ó mhí na Nollag agus go ndúradh liom go raibh siad ar tí é a oscailt ag tús na bliana 2023, tá sé fós dúnta. Ag dul siar, i mí Márta na bliana seo, bhí cur i láthair iontach ó na feidhmeannaigh maidir le réimse leathan de sheirbhísí. Maidir leis an ionad lae seo, dúradh liom go mbeadh sé oscailte. Sin mí an Mhárta agus chuir siad in iúl dom cé chomh tábhachtach is a bhí sé seirbhís mar seo do sheanóirí a bheith ar fáil agus gur nasc iontach leis an bpobal a bheadh ann. Bhí gach rud ráite. B’fhéidir go raibh mé beagáinín soineanta ach chreid mé iad. D’imigh mé as an gcur i láthair sin agus bhí beagáinín dóchas agam. Is i mí an Mhárta a bhí an cur i láthair sin a chuir in iúl dom go raibh an t-ionad chun oscailt. Ansin tá sraith litreacha eile agam anseo a chuireann in iúl nach mbeidh sé ag oscailt sa tseanbhealach ach go mbeidh múnla nua i gceist. Níl sé oscailte fós.
As the Minister of State knows, this issue of the absence of a day centre is important. The day centre in Carraroe, in the heart of the Gaeltacht, has been inexplicably closed since the pandemic. I understand there was a pandemic. The Minister of State and I have had a few interactions and I have said repeatedly on the record that she is hard working. I would appreciate it if she did not read out the reply she has been given by the Department. I am well able to read. We were given solemn promises that the day centre would reopen. I was told in December it was going to reopen in January. I was told at a presentation that it was going to open very shortly. That presentation lasted for an hour and a half or two hours. It was wonderful. It was all about day services and all the other services, specifically in respect of Carraroe. We were down to the nitty-gritty of the Irish language and whether the facility would be able to get staff who could speak it. That was the meticulousness of the discussion in March. Now I have a whole library of correspondence telling me there is a new way of going forward and that the day centre will no longer be operating the way it was. It will now be following a social model, which completely ignores the medical needs of vulnerable people in their 70s, 80s and 90s who utterly rely on a day service for many reasons. I do not need to tell the Minister of State that. I am suddenly being told there is a new social model that is in existence elsewhere. The social model that is operating has advantages but what is the model for the people who need more assistance and who need nursing and social care? What is the model for that treatment? It seems that we are running down the service. We have let problems continue. I received a lot of correspondence before the pandemic when it suited to close the day centre because there was a lack of staff and so on. It is a vital service. I ask the Minister of State to talk to me woman to woman, Minister of State to Deputy, about the importance of this service and when it is going to reopen on a full-time basis.
I thank the Deputy. Tuigim an cheist. I have put my heart and soul into reopening day care centres the length and breadth of the country. More than 300 day care centres are open and last Friday, we opened the 46th dementia-specific day care centre. Another will be opening soon in the Ceann Comhairle's area. We are looking forward to that.
The Deputy will know that the HSE has operational responsibility for planning, managing and delivering health and personal social services. A wide range of core services are provided for older people, including home support, day care, community supports in partnership with voluntary groups and intermediate care, as well as long-stay residential care when remaining at home is no longer feasible. I see the triangle of supports to support older people to stay at home as the following - day care, home care and meals on wheels. That is the vital triangle of support. It is important. These services are fundamental to the health and well-being of our older population.
We all understand that access to day centres can make an important contribution. Older people benefit from the physical activity, cognitive stimulation, enhanced nutrition, healthcare monitoring and social work support. I have visited day care centres the length and breadth of the country and have only ever been in one where a nurse was present. It is a social care model of which we are proud, to support people to go to day care centres to have hot nutritional meals. Supports can be provided to anybody who has issues with clothing or who needs to be bathed. All those supports are still in place.
Day centres are also an important indirect resource for carers. What day care centres do is important to lonely people who have found it hard to reconnect. Their reopening as quickly and as safely as possible remains a priority. We are seeing progress in their reopening with about 91% of services reopened to date. The national service plan sets a target to have 95% reopened, with a stretch target of 98%, by the end of the year. The only day care centres in the country that have not reopened are those adjacent to or associated with a community nursing unit. The HSE has advised that day care services in Áras Mhic Dara, which were provided before the pandemic in the communal areas for residents of the community nursing unit, cannot be provided again in their previous manner due to regulatory and infection control compliance requirements. An alternative area within the centre has been identified and the plan was for the HSE to resume the service on a phased basis, initially for one day per week.
It is expected that the day care service will eventually be able to cater for eight to ten people.
No HSE day services are provided on a walk-in basis and require a referral by a healthcare professional. Áras Mhic Dara day care service was scheduled to reopen on 10 May, however the HSE had only received one referral at that time. As a result, the reopening date was postponed until 17 May. However, by that time it had still not received any further referrals. The HSE has assured me that if additional referrals are received, the service will reopen with haste. HSE healthcare professionals working in the community will ensure residents of the surrounding area are made aware that the service is available and the HSE hopes to see additional referrals within the coming months. In addition, this message will be communicated through local media, which is important.
Twenty-one day care centres have reopened in Galway. I am conscious of Áras Mhic Dara and have asked my officials to monitor the position and advise me of developments. It is important that the word gets out to the community that the day care service will reopen if there are enough people to use it.
Honestly, I despair. It is 11.50 p.m. I absolutely despair. The day centre was opened for one day and absolutely nobody was informed. We have to get some honesty from the HSE. I desperately tried to work with it. I went to a presentation in March, as I told the Minister of State. Representatives of the HSE told me the centre was going to reopen. They did not tell me anything about a new model. That only emerged in April. Does the Minister of State understand? They kept telling us it was going to reopen. They said it was a vital service and then began to change their minds. I have looked at the HIQA report. I know HIQA does not inspect day centres-----
It does not.
-----but, suspiciously, it has been out three times. It has produced two reports and I am waiting on a third. The earlier report, which was published the year before last, included mention of a day centre. The next report did not mention a day centre. It seems to me that the HSE is utterly failing in its duty. There was a lot more honesty in the past. Let me refer to the words of an official, who I will not name, in 2018. In reply to an email, he stated the HSE cannot get agency nurses. This was in July 2018. The part for which I am praising the man was where he mentioned it was most regrettable that the most vulnerable in the area were the ones most affected.
How many were attending the place before it was closed?
Approximately 15 were attending.
Was that on a daily basis?
That was on a daily basis every day.
Where did they go?
That is the question. I have any amount of emails begging me to draw attention to what was happening prior to the pandemic because of problems with staffing. The day centre was allowed to go so the nursing home could keep opening. The beds in the nursing home are empty. This was a wonderful facility that got praise from HIQA. It failed to be compliant on two of the criteria but I do not need to go into that now. It got super praise but also had to take remedial action. The day centre is vital for the Gaeltacht and the language. The way it is being minimised and reduced to a social model somewhere else does not recognise its importance to the area in keeping people healthy while reducing the pressure on the hospitals and so on. Clearly, some people need both nursing and social care in a day centre.
I am extremely proud of the social care model we have in Ireland.
I am not arguing about that.
We run a social care model for day care and meals on wheels. I was abroad last year, representing Ireland as the Minister of State with responsibility for older people, at an event organised by the UN that included approximately 40 different ministers. The number of people who came to talk to me about the social care model we have in Ireland was unbelievable. There is still a medical model in, for example, the UK.
Excuse me for interrupting but I am not arguing with the Minister of State about that. I am arguing about what I was told by the HSE. I apologise for interrupting.
That is no problem. The only area we are challenged is in respect of day care centres that are part of or associated with a community nursing unit. These are residential facilities and it is no longer appropriate to bring people from the community into a community nursing unit because believe it or not, we are still dealing with Covid-19 in those areas, as well as other respiratory illnesses and flu. The situation has changed. At a previous time, people could come in from the community.
They were able to share the same dining rooms and the same sitting rooms. That is no longer possible. In that case, and not only in Áras Mhic Dara but all over the country, the 7% or 8% of nursing home day care centres that we have not been able to open are still closed because they are associated with a HSE community nursing unit. I have asked those that are open to put more of an effort into communicating with older people residing within the local community to let them know that they are open, and they have done this. Obviously, they did not know it was open because they would have come if they had known. In addition, the message will be communicated through local media. Since day care centres reopened, we have seen that not as many people are attending them as before. People are finding it harder to reconnect. People who used to attend three or four days a week are now happier with one or two days a week. For this reason, many of our day care centres are only open three days a week.
I think this is the fifth time that Deputy Connolly has raised this. I know she is frustrated but I will make sure the information will go out. I am keeping on top of this. As soon as they have the appropriate numbers - they have said eight is appropriate - the day care centre will open. I know the Deputy will do her bit to advertise that fact on her own media platforms.
Cuireadh an Dáil ar athló ar 11.51 p.m. go dtí 9.12 a.m., Dé Céadaoin, an 24 Bealtaine 2023.
The Dáil adjourned at 11.51 p.m. until 9.12 a.m. on Wednesday, 24 May 2023.