Nithe i dtosach suíonna - Commencement Matters

Nursing Homes Support Scheme Review

I welcome the Minister of State at the Department of Health, Deputy Finian McGrath, who is here to respond to the first matter, which is from Senator Colm Burke.

I thank the Minister of State, Deputy Finian McGrath for coming to the House to deal with the issue pertaining to the nursing homes support scheme, known as the fair deal scheme. As I understand it, a review was to be carried out but the representative organisation, Nursing Homes Ireland, and all those involved in providing nurse home care under the fair deal scheme were led to believe that the review would be carried out as long ago as 2016. Nothing has occurred and a number of different dates were mentioned as to when the review be published but that has not happened.

The major challenge facing nursing homes is that their costs have risen. The cost of nursing staff and of care assistants has risen. A significant number of staff, who previously worked in the nursing home sector have been taken on by the HSE and nursing homes are finding it difficult to employ others to replace them because their charges are stuck at the same level as they were four or five years ago, whereas costs have continued to increase. A review was promised, dates were set out at an Oireachtas joint committee as to when the review would be published. This has not happened and at this stage clarification needs to be provided in order that the nursing homes can continue to provide the service to the approximately 23,500 people who are in private nursing homes under the fair deal scheme.

We have a growing elderly population and there will be more demands on the system and people are not encouraged to invest in this sector unless they know that what they will be paid for the service they provide corresponds to the rising costs of running these facilities.

I ask the Minister of State for clarification on this matter.

I thank Senator Colm Burke for raising and highlighting this very important issue.

The nursing homes support scheme, commonly known as the fair deal scheme, is a system of financial support for those in need of long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. Approximately 23,000 people are availing of long-term residential care through the scheme at any given time. The National Treatment Purchase Fund, NTPF, has been designated by the Minister for Health, pursuant to section 40 of the Nursing Homes Support Scheme Act 2009, as a body authorised to negotiate with proprietors of registered nursing homes to reach agreement on the maximum price that will be charged for the provision of long-term residential services to nursing home support scheme residents.

As part of this function, the NTPF enters into approved nursing home agreements with registered private and voluntary nursing homes to record the maximum prices that have been negotiated. The NTPF takes the following guidelines into account in negotiating the prices: whether costs are reasonably and prudently incurred by the nursing home and evidence of value for money; prices previously charged; local market price; budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of all of the public. The NTPF is independent in its functions in reaching maximum pricing agreements with proprietors of registered nursing homes.

The report of the nursing homes support scheme review, published in 2015, identified a number of issues for more detailed consideration, including a review of the pricing mechanism used by the 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. A second issue identified by the report was increasing the transparency of the pricing mechanism so that existing and potential investors could make as informed decisions as possible and a third was ensuring adequate residential capacity for those residents with more complex needs.

As the Senator himself has said, a steering group was established in 2016 to oversee and manage the pricing review. The steering group was chaired by the NTPF and included representatives of 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 have been considered in great detail. It is recognised that any change to any part of the scheme must be considered in terms of short-term and long-term impact on the viability of the scheme and accessibility of long-term residential care in general. I am pleased to advise Senator Colm Burke that the review is expected to be completed very shortly.

I thank the Minister of State. My only concern is with the definition of "shortly". This matter has been going on since 2016. There are complex issues involved. The problem we now have is that there are complex cases in the private nursing homes sector. These homes are not being funded to the same level as HSE-run facilities. To give the Minister of State an example, I know of two units of 100 beds each, both of which were built within the past ten years. One is run by the HSE and the other by the private sector. They are both HSE facilities. The unit run by the private sector is costing €900 per week per bed. The unit run by the HSE is costing €1,500 per week per bed. That is a difference of more than €600 per week. This is the problem I have with how funding is allocated. People may come in through the private sector without any major difficulties with regard to their care but as they age their care becomes more complex. The private sector, however, is not getting the same level of financial support to deal with those complex cases. That is an issue that needs to be reviewed.

The other matter that needs to be dealt with, which I know is slightly different, is the HSE not allowing dieticians to visit nursing homes. Great costs arise as a result of that. If dieticians from the HSE were visiting nursing homes monthly it would reduce the level of supplements being prescribed. These health supplements are being prescribed by dieticians employed by their manufacturers. That is another issue which needs to be looked at.

Again I acknowledge the significant input and engagement from across the nursing homes sector that has informed the drafting of this report. This expertise has been considered in detail. I also ask nursing home proprietors to continue the constructive engagement they have had with the NTPF to date and I assure them that the report on the review of the system for setting nursing home prices under the nursing homes support scheme is of utmost importance to my Department.

It is a mark of the success of the health system that life expectancy has increased and our population is ageing. However, we must continue to ensure that, as the health and social care needs of older people increase and they can no longer be supported to live in their own homes, they have access to nursing home places. The nursing home support scheme has supported tens of thousands of people to avail of long-term residential care since its introduction in 2009.

This review is important to the Department and it is expected to be completed shortly. Senator Colm Burke will understand how important it is that full consideration is given to the content of the review so the viability and accessibility of the scheme are assured. Of course I accept his argument regarding the two units, with one costing €1,500, the other costing €900 and the difference of €600 per week, as well as his points about the complex cases and the dieticians. I will convey those concerns to the Minister, Deputy Harris.

General Practitioner Services Provision

Cuirim fáilte roimh an Aire Stáit go dtí an Teach. I thank the Minister of State for taking time from his busy schedule to attend this debate. I wish to discuss the current crisis in general practitioner, GP, care throughout the country and particularly in rural counties such as Monaghan and Cavan. In County Monaghan I spoke to a young couple recently who have just returned home after working in Dublin. They told me they travelled to Monaghan town, where they hope to live, and knocked on every GP's door only to be told that every GP's list was full. They could not get access to a GP. When they went to Carrickmacross they got a similar message. Where are these young people to go for healthcare? The only option available to them is to stand in the queue in the accident and emergency department of the local hospital, which is in Cavan. That is a very sad state of affairs.

Unfortunately, this issue has been with us for some time. GPs have been banging this drum for a long time but the Government has not taken any notice. It has now reached a stage where people simply cannot get access to healthcare. When we get sick the first door we knock on is that of the local GP, but there is a serious problem when that knock cannot be answered. In addition to the shortage of GPs, there is a serious problem with the age profile of GPs. It is estimated that 17% of them are due to retire in the next five years. We are training approximately 180 GPs every year so that illustrates the nature and extent of the problem. Half of the doctors we are training, like many of our nurses and teachers, are jumping on an aeroplane as soon as they qualify and heading off to a foreign land where the terms and conditions of employment are much more attractive. It is a serious problem. I have spoken to some GPs and they told me they are being run into the ground. They are totally stressed out because they simply cannot cope with the numbers coming through their doors. Even when the doors are closed they are still in a serious position and cannot cope.

In summary, we need a health system in which people see the right healthcare provider at the right time and in the right place. The cost of treating a patient in hospital for one night is €1,200. Treating the same patient in their own bed and home costs less than €100. This is a serious problem and must be addressed. It is particularly acute in places such as Monaghan, Cavan and rural areas. We are trying to attract our young people home and to invest in the local economy to create jobs, but there will be a big problem if those people cannot get access to GP care, the first point of access to healthcare when they get sick. I hope the Minister of State will have news of serious attempts by the Government to address this matter.

I thank Senator Gallagher for raising this important issue. I am aware he has a keen interest in healthcare and does a great deal of work in Monaghan and Cavan in respect of my portfolio, which is disabilities.

I am very conscious of that and I commend him on it.

I would like to assure the House that the Government is committed to the continued development of GP capacity to ensure that patients throughout the country continue to have access to GP services and that general practice is sustainable in all areas into the future. I want to ensure that existing GP services are retained and that general practice remains an attractive career option for newly-qualified GPs. As of 31 December 2018, 2,491 GPs hold GMS contracts with the HSE and this is continuing to increase year on year. A further 430 GPs hold other contracts to provide services such as immunisation, Heartwatch, methadone and cancer screening. HSE community healthcare organisation area 1 has confirmed that there are currently 25 GMS GPs in Monaghan covering 27 GMS panels and there are 34 GMS GPs in Cavan covering 37 GMS panels. Two locum panels for Ballyjamesduff and Drumalee were advertised in the national newspapers last weekend, with a closing date for receipt of completed applications of 15 March 2019. The HSE primary care unit is also processing two open entry GPs for Cavan and is engaging with all GPs holding locum panels to discuss the future of these panels. All GMS panels are assigned to a GP and currently there are no panels without a GP. The HSE is not aware of any GMS patients without a GP in Cavan-Monaghan. There are nationally agreed processes in place that ensure that any person who cannot access a GMS GP will be assigned to a GP.

The Government is aware of workforce issues facing general practice - and I take on board the points raised by Senator Gallagher - including the influence of demographic factors, and has implemented a number of measures to improve recruitment and retention in general practice. These include changes to the entry provisions to the GMS scheme to accommodate more flexible shared GMS-GP contracts, and to the retirement provisions for GPs under the GMS scheme, allowing GPs to hold GMS contracts until their 72nd birthday, as well as the introduction of enhanced supports for rural GP practices. These steps should help to address the future demand for GPs by enticing GPs who may have ceased practicing for family or other reasons back into the workforce, facilitating GPs to work past the standard retirement age and encouraging more GPs to work in rural areas.

There has been a huge expansion in the number of places on GP training programmes in recent years. In 2009, there were 120 GP training places available, and in 2018, 193 places were filled, an increase of around 60% over this nine-year period. The objective is to continue to achieve annual increases in the number of training places available while ensuring that all the places are filled.

It is acknowledged that there are many challenges in general practice. I agree with Senator Gallagher's point on this issue. That is why the Government remains committed to engaging with GP representatives on the development of a package of measures and reforms to modernise the current GMS contract.

Talks between the Department of Health, the HSE and the Irish Medical Organisation, IMO, as the established GP representative body, are continuing. Agreement on the delivery of these service improvements and contractual reforms has the potential to facilitate a substantial increase in the resourcing of general practice on a multi-annual basis.

I thank the Minister of State for his comprehensive response to my query. I met a farmer recently who was discussing the lack of GPs and where the country was going. He said it was terrible to think that nowadays if he had a sick animal in one of the cattle sheds in the morning or one which got sick in the middle of the night he could ring a vet and one would be out within a couple of hours but if a mother or father had a sick child and was trying to get access to a GP in some cases the GPs' doors would be closed purely because of their workload. That illustrates in very simple terms the gravity of the situation. I note from the Minister of State's comments that talks are going on. GPs will say they have been going on too long. There is a crisis, particularly in the rural counties such as Monaghan and Cavan.

It is past time that this issue was taken more seriously and that the Government addressed the situation. The Minister of State outlined that there will be efforts to put in place assistance in respect of the medical cards and that those people will be seen at some point. What about the people who are working and do not have a medical card? How are they meant to survive and where are they meant to go if their children are sick if there are no GPs available?

I reiterate the Government's commitment to ensuring that patients throughout the country continue to have access to quality general practitioner services. The Department of Health, the HSE and the Irish College of General Practitioners are committed to working together to improve recruitment and retention in general practice over the coming years. I take the Senator's point and note his story about the local farmer being able to get a vet in a matter of hours. I also take his point on the progress of the talks. The goal of the current phase of the GP contract talks is to reform and modernise the existing General Medical Services, GMS, contract. This will be key to making general practice a more attractive career to young doctors.

In respect of GP services in counties Cavan and Monaghan, I assure the Senator that the HSE is taking all necessary steps to ensure that the current GMS vacancies are filled as soon as possible. In the meantime, local arrangements are in place to ensure services to this community are retained while the recruitment processes are under way. Of course, the Senator has a very valid point on the other issue of GPs in rural areas. I will bring these major concerns back to the Minister, Deputy Harris.

Derelict Sites

I welcome the Minister of State to the Chamber and ask him to outline the role local authorities play in addressing public health concerns arising from dereliction of privately owned buildings. Dereliction of urban areas is an issue we all need to address. The local authorities play a key role in this. Local government is a very important part of our community. It is in charge of roads, housing, business services and many other aspects of our society. When we have a dereliction or safety issue, it is important that local government acts appropriately and responsibly. Exactly 11 weeks ago, a building collapsed at about 2 a.m. in Oliver Plunkett Street, Bandon but nobody was hurt. That street is still closed off and there are signs up on buildings across the way. Ratepayers and a hotel are affected. It has had a major effect on economic activity within Bandon town and the lack of action is being commented on. Do local authorities have the power to deal with such issues? Do they have the power to engage? Can they compulsorily purchase a property to ensure access is opened again? It is a bizarre situation. If a building in Grafton Street or Patrick Street in Cork fell tomorrow morning, I do not think we would be waiting for 11 weeks for a road to be opened. Clarity is required. These are ratepayers and businesses in a proud town that wants to see action. It wants to see reopened a street that is closed off. I seek clarity on what powers local authorities have and when do they use them. If the powers are not strong enough, perhaps we need to legislate to ensure local authorities can act swiftly and competently to avoid having a street closed for three months. It could be closed for another three months for all I know. I do not know when it is going to be opened. Here in Leinster House and in the Custom House in particular, people must use their initiative to instruct the local authorities to act swiftly.

This is a big issue at present. There are derelict sites in many cities and towns and dereliction is an unfortunate issue. We are in the middle of a housing crisis and to have these sites sitting idle is a crime.

How do we get these sites back into circulation and make them produce for our society? I know of a street in Innishannon, County Cork, where there are 11 idle houses. That is totally inappropriate. We have to ensure that the powers of local authorities are strong enough to enable them to deliver vibrant, strong communities. Those communities will not emerge from derelict sites and buildings.

I am looking for clarity on this matter. Do the local authorities have the power to intervene? If not, will we give them such power and, if so, can we instruct the Custom House to get actively involved and ensure the dereliction problem in many towns and villages is dealt with to improve the quality of life of communities and wider society?

I apologise on behalf of the Minister for Housing, Planning and Local Government, Deputy Eoghan Murphy, and thank Senator Lombard for raising this very important issue concerning local authorities and how to deal with public health issues associated with derelict buildings.

There are two legislative enactments that are particularly relevant in this area. The Derelict Sites Act 1990 requires every owner and occupier of land to take all reasonable steps to ensure their land does not become, or continue to be, a derelict site. In the Act, a derelict site is defined as meaning:

... any land which detracts, or is likely to detract, to a material degree from the amenity, character or appearance of land in the neighbourhood of the land in question because of—

(a) the existence on the land in question of structures which are in a ruinous, derelict or dangerous condition, or

(b) the neglected, unsightly or objectionable condition of the land or any structures on the land in question, or

(c) the presence, deposit or collection on the land in question of any litter, rubbish, debris or waste, except where the presence, deposit or collection of such litter, rubbish, debris or waste results from the exercise of a right conferred by statute or by common law.

To this end, local authorities have been given substantial powers under the Act in relation to any such sites. These powers include requiring owners or occupiers to take appropriate measures which, in the opinion of the local authority, are necessary to prevent the land in question from becoming or continuing to be a derelict site. This applies to the initial stages of dereliction. A local authority can also acquire derelict sites, either by agreement or compulsorily, and apply a derelict site levy on the registered owners of derelict sites which should be applied annually for as long as a site remains on the local authority derelict sites register.

Under the Act, local authorities are required to compile and maintain a register of derelict sites in their respective functional areas, which contains the name and address of each owner and occupier of any land which, in the opinion of the local authority, is a derelict site. A copy of the derelict sites register can be inspected at the offices of each local authority during office hours.

Section 59 of the Planning and Development (Amendment) Act 2018 made a significant change to the Derelict Sites Act 1990 to provide that the derelict sites levy will increase from 3% to 7% of the market valuation of relevant sites with effect from January 2020. This increase is intended to ensure that the measure can have more meaningful impact and incentivise owners to bring derelict sites back into productive use at an early stage. This is a very significant change. It does not take away from the Acts I have already mentioned, but rather added to them.

The second legislative enactment providing local authorities with powers to address public health and safety concerns associated with derelict structures is the Local Government (Sanitary Services) Act 1964. The Act is old but I believe it has been fairly effective. A dangerous structure is defined quite broadly as any building, wall or other structure of any kind that in the opinion of the local authority is likely to be dangerous to any person or property.

Under the Act, local authorities are empowered: to give notice to an owner or an occupier of a dangerous structure to carry out such works, including the demolition of the structure or the clearing and levelling of the site, specified in the notice in order to prevent it from being a dangerous structure; to remove any debris and to erect a wall or barrier between any open area created by the works and any road, street or public place and to terminate or modify any use of the structure or part of the structure; and to enter land to undertake works that a local authority believes are necessary in order to prevent a structure from being a dangerous structure and to carry out the necessary works itself. It should be noted that where a local authority is obliged to undertake any works in relation to a dangerous structure, the local authority can seek to recover any costs or expenses incurred by it in undertaking such works from the owner of the property concerned.

The Act also imposes duties on the local authority to maintain a register containing the details of all orders made in relation to dangerous structures and the register must be available for public inspection. In the case of both the Derelict Sites Act and the Local Government (Sanitary Services) Act, failure to comply with a notice issued by a local authority is a prosecutable offence.

I compliment the Minister of State on his response. In the three years I have been here, I have rarely received a response that pointed out the law dealing with the issue in question. I asked if the local authority had powers to deal with the issues and it is very clear from the Minister of State's response that the 1964 Act, which is very comprehensive, gives the local authority exceptional powers to levy the cost of this on the owner of the site and provides a mechanism to recover the costs, if required. We now need the local authority to show the will to do this. It has the power but, as I asked, why is it not using this power? That is the big issue. We have proved that it has the power under the 1964 Act so I ask the Minister of State to go back to the Minister, Deputy Eoghan Murphy, and ask him to engage directly with Cork County Council and ask it why it is not using the powers it has under the Act. It has the explicit power to get its money back for the works it undertakes but a street has been closed for nearly three months and could be closed for another six months. We need Cork County Council to move and to deliver on this. The Minister should get involved with this case to ensure the local authority delivers on its role as an important driver of local and community issues.

This is a very important issue locally and ratepayers will not be there in 12 months' time because of the powers under the 1964 Act not being invoked. We have the legislation, now we need goodwill and activity on the part of Cork County Council.

When I received this question I carried out an assessment of the situation. I was a councillor for a number of years, like the Senator, and I looked at the Derelict Sites Act 1990, as well as the Planning and Development (Amendment) Act 2018. With these Acts and the 1964 Act, it appears that local authorities have sufficient powers. The problem is that it is a matter for individual local authorities to determine the most appropriate use of what powers are available to them. I am not in position to say, but maybe an assessment should be done by the Department of how many times local authorities have used the Acts of 1964, 1990 or 2018 in respect of derelict sites and whether the Acts have had any impact.

In 2020 there will be an increase in the levy on market valuations from 3% to 7% but the Senator is right that sufficient powers exist for local authorities in the three Acts referred to. It is a question of whether they use those powers and how often they do so. I am only speaking on behalf of the Minister but I read the legislation this morning.

What is probably necessary and what would be a useful exercise is carrying out an assessment of local authorities to assess how many derelict sites there are and identify how many times under any of the Acts the owners or occupiers have been contacted. What the Senator said is right. If he sends me the details of the particular case with which he is dealing, I guarantee that they will be passed on to the Minister.

I thank the Minister of State and the Senator.

Sitting suspended at 3.10 p.m. and resumed at 3.30 p.m.