Health Services Provision: Statements

I welcome the Minister of State, Deputy Jim Daly, to the House and I ask him to make his contribution.

St. Joseph's in Shankill is part of the St. John of God Hospitaller Services Group. It provides residential care and day care for service users, all of whom have a diagnosis of dementia. Most of the 60 residential places are funded through the nursing homes support scheme. Separately, the HSE contracts for approximately 25 day care places per day at St. Joseph's.

It is most regrettable that residents, their families and the service users of St. Joseph's are in a state of anxiety with regard to the services of which they avail. My overriding message to all parties involved is to use the mechanisms available to engage on the matters of concern.

Recognising the challenges faced by people living with dementia in Ireland and to provide services that will meet growing demand in future years, the Government launched the national dementia strategy in December 2014. The strategy's purpose is to increase awareness of dementia, ensure timely diagnosis and intervention and develop enhanced community-based services, in line with the vision of Sláintecare. The HSE's national dementia office is developing a framework for dementia diagnosis and post-diagnostic supports, the testing and delivery of intensive home support packages and a programme to upskill GPs and primary care teams in diagnosing and managing dementia. The Dementia: Understand Together campaign has also been a major success in making a difference in bringing down the walls surrounding dementia.

In budget 2020, further investment was committed to provide ten additional dementia adviser posts as part of the drive under Sláintecare to reduce our dependence on care in hospitals and support healthcare delivery in the community, along with significant investment in delivering an additional 1 million home support hours in 2020. The Government remains committed to the full implementation of the national dementia strategy and to ensuring that people with dementia can access the services they need to live as well as possible in their own homes and communities for as long as possible.

The nursing homes support scheme, commonly referred to as the fair deal scheme, is a system of financial support for people who require 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. The scheme aims 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 nursing homes support scheme is expected to support 23,042 people at any one time in 2019. Its budget for 2019 saw an increase of €24.3 million over 2018, making a total budget of €985.8 million for 2019. In 2020, the scheme will see a further investment in its budget of €45 million, bringing its total annual budget to €1.03 billion. This substantial investment will provide ongoing long-term residential care over the course of 2020, ensuring the scheme continues to deliver affordable and accessible nursing home care for our citizens with long-term care needs.

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 non-HSE registered nursing homes to reach agreement on the maximum prices that can be charged for the provision of long-term residential care services to nursing homes support scheme residents. The NTPF has statutory independence in the performance of its function and negotiates with a nursing home on an individual basis. The Minister for Health does not have any role in this regard.

The NTPF has clear established processes for agreeing prices and has successfully negotiated terms with more than 430 private and voluntary nursing homes participating in the scheme. The NTPF's processes are available to all nursing homes, and since the end of 2017 there has been a net increase in the number of nursing homes operating in Ireland, with an increase of almost 1,300 in the number of beds in the nursing homes with which the NTPF has agreed terms.

In the context of its statutory role in negotiating maximum prices charged for the provision of long-term residential care services to NHSS residents, the NTPF established processes are the appropriate mechanism for engagement. The established processes include provision for an NTPF review mechanism where agreement is not initially reached on the price. I understand that the initial engagement and negotiation between St. Joseph’s and the NTPF is currently active. Given the NTPF’s statutory independence in the performance of its functions, it would not be appropriate for me to comment any further. As indicated at the outset, engagement through the established mechanisms is the prudent and appropriate course of action.

The HSE has been in extensive engagement with the St. John of God Hospitaller Services Group with regard to the day care service at St. Joseph's and this engagement is ongoing. The HSE has further committed to continued intensive engagement on this matter before the end of 2019. I acknowledge the role of private and voluntary providers in residential care provision. I encourage the St. John of God group to continue its engagement with the HSE with regard to day care services in the context of the HSE's commitment to engagement. I understand that the HSE will endeavour to meet with St. Joseph's in the coming days with a view to continuing the positive dialogue and to try to find a satisfactory resolution to the issue.

Day care centres play an important role in supporting older people to remain in their communities by promoting well-being, preventing or delaying health deterioration, supporting them to remain independent, and supporting the carer. There are in the region of 300 day care centres across the nine community health organisations. They offer services which include nursing and therapy supports, social activities, chiropody and some personal care. The centres play a key role in facilitating early discharge and hospital avoidance.

I recently announced the approval of €1 million in grant funding for community and voluntary groups under the community and voluntary supports grant scheme launched earlier this year. This initiative will provide additional funding to community and voluntary groups to continue to support older people, family carers and significant others to stay well and remain connected with their local community. The funding will support an additional 20,000 meals on wheels per annum, 90 additional day care places per week, 13 new or expanded social centres and 19 befriending projects.

Before I call Senator Davitt, I welcome Councillors Eddie Fitzpatrick and Cormac Devlin to the Public Gallery. They are very welcome to this Chamber, to which councillors elect 43 Members.

I also extend a welcome to my neighbour, who we call Eddie Fitz in my part of the country, and to Cormac Devlin, who has talked to me about this issue on a number of occasions. He is very active in the area and is a great representative for the community. I am deputising for Senator Swanick, who is attending a meeting elsewhere. The Senator was in contact with the Minister of State's office in that regard.

St. Joseph's in Shankill reports that it will be forced to cease its day care service from January and gradually wind down the entire facility unless more public funding is provided this year. St. Joseph's is currently operating at a major loss and the funding gap is getting wider each year. The home gets funds from the fair deal scheme but not enough to cover its bills. The money provided by Government has not increased since 2006 and costs have risen rapidly since then. It has been trying to plug the gap with help from St. John of God's, as the Minister of State has mentioned, but in 2019 alone the shortfall will reach €1 million, which is quite a lot. The Government is refusing to take responsibility for the problem and is trying to pass the buck while citing a report on the fair deal scheme which will apparently be used to decide whether funding rates are appropriate. That report has been delayed by two years. In the meantime, the threat of closure hangs over St. Joseph's. The care, compassion and clinical expertise that patients are given in St. Joseph's cannot be understated. Closing it would be disastrous for the vulnerable residents but would also have a terrible knock-on effect for families who will have to deal with the stress and worry of finding somewhere new for their loved relatives.

The St. John of God group has been lobbying the Department of Health and the NTPF in recent months for a significant increase in reimbursement payments for inpatient and day care. St. Joseph's has covered the €7 million financial shortfall from its own resources since 2012 but another €1.2 million is needed next year. Some 120 patients attend St. Joseph's day care services and 60 live there full-time. The CEO of St. Joseph's has requested a weekly payment of €1,785 per resident. Most residential places at St. Joseph's are funded through the fair deal scheme but the rate is insufficient as it does not take account of the dementia-specific and palliative care needs of these residents who have a terminal diagnosis. Numerous HSE nursing homes are getting paid more than the rate St Joseph's is asking for despite not specialising in the same expensive treatment. Dementia care is an end-of-life palliative process and St. Joseph's simply cannot continue to offer this specialist long-term care based on the current funding model applied by the NTPF and the HSE. It is paid at considerably lower rates than equivalent public facilities despite the additional costs associated with meeting the high-dependency needs of the people cared for there.

The truth is that none of this needs to happen. All of this could have been avoided had the Minister of State listened to the warnings regarding the financial situation at St. Joseph's when Deputy Donnelly first raised them in the Dáil in June. Now, the State's largest nursing home specifically for dementia patients faces closure over a funding crisis. The Government is abandoning some of the most vulnerable people in society.

I was happy to read that statement on behalf of Senator Swanick. I listened to what the Minister of State had to say, which was important, and I appreciate that he is here today to discuss the matter. He provided a lot of detail on many issues. He told us about the €1 million in grant funding, the 300 day care centres and the services provided at St. Joseph's. He told us everything but he did not mention anything specific about keeping the residents in the centre and the deal he is trying to strike with the St. John of God's group, if he is, if fact, trying to strike one. He said that the HSE has been talking to the board and, since St. John of God's has been covering the overrun, it will be the board that decides whether the service will continue. I am a little bit disappointed that he could not tell us that we were 50% of the way to a solution or that we have been able to deal with some of the shortfall although without agreement on the overall figure. I am sure anything that would help to keep these people where they are would be a better response than closing the centre. The Minister of State knows that, if it does close, significant amounts of money will have to be spent to settle these people elsewhere.

I appreciate the Minister of State being here and the compassion he has shown in respect of this issue but will he go off script and enlighten us a little bit more about some of the detailed discussion that has taken place? I would appreciate it if he did that for the sake of the people involved.

I welcome the Minister of State. This is a matter in respect of which I have a particular interest and about which I have particular concern as a proud member of the Oireachtas dementia group. It is via the latter that my colleagues and I work hard on this issue. I refer particularly to Senator Humphreys, who is also a champion for those with dementia. I have to confess, I feel a sense of déjà vu. These discussions bring to mind those we had in the summer of 2018 with regard to the closure of Linn Dara day hospital, which was to reopen. Is scéal eile é sin. It was promised, it just never occurred. I want to give a particular shout-out to the Alzheimer Society of Ireland in light of all the work it does in supporting the work of the Oireachtas group. We work well, creatively and cleverly together.

Last November, the St. Joseph's campus was a finalist for a nursing home award. These awards are a national celebration of outstanding care provided, innovative care and best practice. They are the Oscars of the nursing home sector. Testimony from carers, families, patients and the wider community acknowledges the massive difference the facility makes to their loved one's lives. Care is delivered in the best way possible for people living with dementia and their families. My office spoke with representatives of St. Joseph's earlier today and they told us the quite startling fact that use of psychotropic drugs in their service has dropped from a massive 78% to 23%.

For too long, people living with dementia were chemically drugged with heavy doses of psychotropic medication, which hastened their physical and cognitive deterioration. These are great statistics, which show the great action taken by staff at the centre. Restraint mechanisms are not used to manage patients. This shows the high quality of care that is unique.

A few months ago, I had the privilege of hosting the writer, artist and anthropologist, Dana Walrat, in the audiovisual room. Ms Walrat wrote an amazing book, Aliceheimer's, which documented her mother's journey with Alzheimer's disease. She is a recognised international expert. We spent a lovely weekend roaming around Dublin. She was delighted that we in Ireland treat and care for people with dementia care using a social model as opposed to the medical model prevalent in the United States. She found that wonderful, a great way of looking at the person and his or her environment and needs as opposed to strict medical diagnosis and medical management. Under the social model, people are integrated in their community where they can socialise and be with others. This holistic approach is exemplified in the model adopted by St. Joseph's.

My colleague, Deputy John Brady, who met management and staff at St. Joseph's, described the ethos in the facility as patient centred and said it provided a class A1 standard of care. He also told me about the many volunteers who contribute to the running of the centre which provides this vital service. There are two parts to the St. Joseph's service, as the Minister of State outlined, its day care service and its residential facility. The Minister for Health, Deputy Harris, was reported in the Wicklow Times this week as saying he would not allow the centre to close. At a glance, that is a very welcome statement but if we dig a little deeper, we find concerns. The Minister indicated that the continuation of the residential facility is guaranteed under the National Treatment Purchase Fund. Is this the assurance he was giving when he said the doors would not close? The day care centre is funded by the HSE. Given our vision of moving away from loading the fair deal into community provision and allowing people to remain independent, day care services will become a vital part of providing that. If we close this facility, we would be shooting ourselves in the foot because there are so few such places around.

Last week the Minister said the HSE was intensively engaging, as the Minister of State reiterated today, to try to agree additional funding to keep St. Joseph's open. This is the crux of the worry. Intensive engagement is not enough. St. Joseph's engages in intensive negotiations every year just to maintain its services. The Minister appears to frown on the decision by management to alerting residents and their families to the situation. Management has a duty of care to notify if the service will not exist at the end of the year. These discussions have been ongoing so announcement of intensive engagement is nothing more than a distraction. If the Minister is serious about the service staying open, it will mean more than keeping the doors open. The management need and deserve a legally binding agreement on funding in order that it can fulfil its responsibilities to patients.

There is a wider issue here regarding private, public and not-for -profit services. There are serious question marks over whether there is a level playing field. We need to address this issue. A vital first step in doing so would be to have the National Treatment Purchase Fund review published. The review would give us some of the information we need and recommendations to tackle this problem in order that it does not continue to arise around the country.

Let us not forget in all this talk what this facility means to the families and the many residents who call it home. The fear they are experiencing is very upsetting for them and their loved ones. We should not disguise the truth. We need more than a commitment that the door will not close. There must be a full financial plan to secure the continuation of both the day care and residential services, as well as a plan to tackle the wider issues at play here. I look forward to contributing to that process. We must keep in mind that day care places will become a much needed resource when we implement the vision of allowing everybody allowed to stay in their own homes.

I am grateful to the Minister of State for attending this debate and giving such a lengthy opening statement. I am also grateful to my colleague, Senator Colm Burke, the Fine Gael health spokesperson, for allowing me to substitute for him today on basis that I am familiar with this matter, both as a local representative and from my time with Councillor Devlin on Dún Laoghaire-Rathdown County Council. I must give credit to Senator Humphreys whose tireless efforts on the Order of Business last week ensured we were able to have statements on this crucial topic.

We have discussed many issues, most importantly the funding shortfall and the real concern among the 100 staff of St. Joseph's who provide such excellent care to many people. The community, not only in the Shankill area, but throughout south Dublin, north County Wicklow and into County Wexford, rely on the services provided by St. Joseph's. I must echo the call that rather than continuing with intensive engagement, we must get a resolution to this issue which provides certainty to patients, their families and all those connected to this facility.

Regardless of how it is phrased, the statement by the Minister for Health, Deputy Harris, that this facility will not close is welcome. We need to see the flesh on the bone and the full detail of what is planned for this very important facility. Many people in my area benefit greatly from the services it provides. They are given great peace of mind, knowing their loved ones are receiving the best quality treatment from those who know them and care about their health. Senator Devine eloquently laid out some of the advances that have been made in this facility over the years, which could serve as models for similar facilities throughout the country.

I was contacted by a lady in Dundrum whose husband has been cared for in St. Joseph's for some time. She told me he has a wonderful life there and it is his home away from home. Surely that is what we should advocate and seek in all such facilities but to do that we need to ensure that patients such as the husband of the lady in question are protected and can continue to avail of the superb standard of care offered by St. Joseph's. That can continue with guarantees and assurances. I urge all those concerned about this matter to allow the negotiations to run their course and not to panic. I underline, however, that we need to see a conclusion to those negotiations. While I fully appreciate that the Minister and Minister of State cannot engage directly and we must allow the negotiations to take their course, time is of the essence. Those who have concerns for their loved ones need to be certain their loved ones will be looked after.

I do not want to take up much time because many Senators want to contribute to the debate. I underline how important it is to many of the people I deal with to know that this facility is there and their loved ones are being cared for. St. Joseph's has become a vital part of our community and anything that can be done should be done as quickly as possible.

I will be brief because I have had a look at the Minister of State's statement and I do not want to repeat what previous speakers have said, other than to say that it should never have come to this. It is as simple as that. Fine Gael is in government and has known about this issue because it has been ongoing for some time. I have spoken to some people in the St. John of God Hospital group who are involved. It was unsustainable that it had to keep dipping into its own resources to keep services afloat. This is not a new issue that arose last week or the week before. It has been going on for months.

I should declare that I was a director of the National Treatment Purchase Fund for two terms. I am, therefore, fully aware of the NTPF's role in organisations similar to this one and the power of negotiation in fixing prices. There must be consistency. For every case where there is a problem, a balanced approach must be taken and one must be mindful of the overall picture. I appreciate and understand that.

It is of some comfort that the Minister for Health, Deputy Harris, has given an assurance that St. Joseph's will not close. Why would he not do so given that the facility borders on his constituency? It falls within the Dún Laoghaire electoral constituency but matters related to health should not reflect on the political landscape around it. The reality, however, is that this facility is located close to the Minister's constituency. It is disappointing that it has taken so long to address this issue. It has come to the stage where the owner and provider of this service, the St. John of God Hospital group, had to indicate its concern. Ultimately, as Senator Devine said, it had to give notice to the carers, families involved and the staff and management in St. Joseph's and flag its concern. It would have been irresponsible of it to have left it any later to do so.

It has, however, focused minds because we are talking about it today. As a member of the Joint Committee on Health, I suggest asking the Minister and his officials to come before the committee, along with some of the providers of the service, to explain what is happening. We have to keep the momentum going. I welcome the fact that the Minister of State is here and I have always been extremely supportive of him because his heart is in the right place. I am sure that if he could write an open cheque for this he would do so. It is important to keep the pressure up, from all parties in this House and the Dáil, and the health committee should raise it. It is about how we treat our most vulnerable people, be they young people, people with disabilities or older people, who are the majority though I also know a brother and sister aged under 60 who live in this facility. Alzheimer's disease and dementia do not just hit older people. These two people do not even know they are brother and sister on the same premises and that is a story in itself. I suggest we raise the matter in a week's time in the Seanad as we need to keep it going and to give comfort to families and carers. I acknowledge the staff at the top and bottom of this organisation, which I know well because I visit it on many occasions. It is an amazing service - a purpose-built facility which is a model for the way we should be caring for people and could be replicated many times over because the demand exists for it across the country. Let us keep the momentum up for a resolution to something that should never have come this far.

I was fuming with anger when this came up last week, to the point where I demanded the Minister attend the House. The fact that the Minister of State has come in is a compromise. Has my anger diminished? No, it has not. In the Dáil last week, the Minister, Deputy Harris, said the doors would not close. He said St. Joseph's was a brilliant facility that needed to be supported and that it would be supported and remain open. That is not what the Minister of State said in his contribution today, however. He said the National Treatment Purchase Fund had statutory independence in the performance of its function so the Minister for Health should not have given that commitment last week. It has not been negotiated and funding has not been secured. We need to get away from soundbite politics that just push dementia further down the line, which is what has been happening for the past three years. The all-party group on dementia has raised dementia and Alzheimer's over and over again and the Minister of State has been buttonholed on the issue on several occasions in the past three years. We saw some movement on it in the budget but it was very small. It was fought for very hard by families whose loved ones suffer from dementia. In the media, we read that they have been told they may lose 120 day places and that the service for full-time care will be closed. Why would everybody not seethe with anger about this? The anger is still there because we are being fobbed off again and are not getting definite commitments from the Minister of State that St. Joseph's will stay open and that people suffering from dementia will be treated with respect.

I will remain angry until there are meaningful supports for patients suffering from dementia and their families. For the past three years they have not been treated well. The Department's report of 2015 stated that the fair deal scheme was not fit for purpose and that fees payable to high-dependency patients in nursing homes, meaning the likes of St. Joseph's, were not viable. We are two years past the implementation of that report and nothing has happened. I prefer to stay in the community as long as possible but the Minister was asked if people who are suffering from dementia and who have to go into nursing homes could be treated as having a terminal illness, like cancer, and get similar funding. Why is that not happening? According to the Minister for Finance, we are out of the fiscal crisis so why have reports commissioned by the Department not been implemented? Why has there not been a proper rolling out of services for people with dementia, rather than their families being told they could be turfed out and that they would have to find somewhere else for their loved ones?

I am not happy with the Minister of State's answer to this. Can he explain why the review system for nursing home prices under the nursing home support scheme are outstanding, four years after the report and two years after its implementation date? Are people scratching themselves in the Minister's Department? We are not seeing delivery though we are seeing report after report. We are running budget surpluses and the Taoiseach spoke of them with glee this morning, while we are leaving families to suffer. They are working and doing their best but they cannot launch political campaigns and regularly stand at the doors of Leinster House to demand a proper service for their loved ones, although they did this a couple of weeks ago. It is heartbreaking to see these family members having to organise protests for their loved ones to be looked after correctly, decently and with respect, while letters are sent to them telling them they are going to lose their services. The letters were issued in desperation because St. Joseph's cannot run a deficit of over €1 million, year after year. The hospital had a responsibility to say where it stood and it was criticised for doing so but it was wrong to do that and it was only another media soundbite.

I ask the Minister of State to use the same words to reassure me as his senior Minister used, by telling me the doors will not close. St. Joseph's is a brilliant facility that needs to be supported. I ask him to back up his senior Minister's soundbite because if he cannot do that, it shows it is only a soundbite and that is not good enough. We want it said loud and clearly. The Minister should tell me that, without any doubt, the doors will remain open and St. Joseph's will be supported. I ask him not to give me any of the bull about independent groups and reviews but to reassure me that what the Minister said in the Dáil is correct.

I thank Senator Humphreys and the all-party working group on dementia for getting this debate onto the agenda. This is a hugely important issue for me and I am shocked that it is even necessary to have the debate. A friend of mine, Don O'Neill who lives in New York, is a very well-known fashion designer and he held a fashion show as a fundraiser a couple of years ago. I went along to support it but I had no understanding of the great work the hospital did until then. They showed videos of families and people with dementia, including young people who had dementia in their late 40s and who have children aged 18 or 19. It was heartbreaking. We have had long discussions about the resources allocated in the budget to vital services, yet we are now discussing the potential closure of an essential care centre which is relied on by many families and vulnerable older people.

I thank the Minister of State for being here today. This must be difficult for him because he is a very compassionate man. The figures laid out by my colleagues are stark. St. Joseph's in Shankill is the largest dementia care home in the country, which provides mostly end-of-life palliative care on a not-for-profit basis for people suffering from dementia. Over 60 people live there. The Minister of State knows all this. It also provides a further 120 day-care places. The home has been struggling with funding since 2012 and at this point the day-care centre may close as soon as January, with the entire facility being wound down not long after that. That is really shocking. What are those 120 families supposed to do? What are the 60 people with dementia currently living in the facility supposed to do? It is unacceptable that those families are facing into Christmas and the winter months with this horrible uncertainty looming over them. We are talking about a matter of weeks. At a minimum, we need a short-term funding allocation in order to provide security and comfort for the people involved and to allow time to meet with the management and figure out longer-term support. People watching this debate are unsure as to whether their loved ones with dementia will have somewhere to go in a few weeks' time.

This is depressing, to put it lightly, and it is unacceptable that we are having this conversation in one of the richest countries in the world. I believe we are the tenth richest country in the world. We have a duty of care to the most vulnerable in our society and it is heartbreaking that they are facing a closure such as this one. Politics is to a large extent a question of how we allocate resources. I understand that we have competing demands and endless trade-offs for what we can do. However, I firmly believe that a certain level of care and well-being is simply non-negotiable and represents a moral floor below which nobody in this country should be allowed to fall. In a republic worthy of that name it should be taken as a given that we provide a basic standard of food, shelter, education and healthcare, which we should set as our minimum standard. That is how a wealthy country should act, by looking after its most vulnerable. That is what we should be doing. It should be our top priority. Beyond this, we can have a debate and weigh up the costs and benefits of how to allocate resources, but only above this line, once the basic needs of care and dignity are met.

I am sorry to say that we are failing badly when it comes to housing. Given that the families of 60 people suffering with dementia have had to launch a public campaign to keep their vital support service open, it is clear that we are failing in healthcare too. The figures show a €7 million shortfall, which is mostly due to essential capital investment to meet targets set by HIQA. St. John of God Hospital has been making up this shortfall for several years but it is becoming unsustainable. It seems a further €1 million will be needed next year. These figures are alarming but we have to put them into perspective. We need context when discussing resources and trade-offs. Every year, the Irish State pays €17 million to the greyhound industry and essentially pours public money into it in order to keep commercially non-viable tracks afloat. That should serve as a stark reminder of the levels of money about which we are talking and how our priorities are reflected in the budget. We are debating a small amount of money that is needed to provide vital supports for dementia sufferers and which pales in comparison with many of the other lines in the most recent budget. It is simply not good enough. I join my colleagues in calling on the Government to make sure this vital service is maintained. We should be debating how this service can be replicated and expanded across the country, rather than being closed prematurely.

I thank each of the Senators who contributed to the debate and acknowledge their commitment and passion. Nobody has taken advantage of this situation and all are genuinely concerned about this issue, which I always appreciate. I have a prepared script, but I will be brief in order to address the issues the Senators have raised with me directly. I will not rerun everything I already said, but I stress that these Houses dictated that the NTPF must deal with nursing homes individually and independent of the Minister of the day. If the Houses want to change that and believe the Minister should do the negotiating, we can debate it and the Minister can get involved. As of now, according to the law of the land as set by this House and the Lower House, negotiations are conducted by an independent body, namely, the NTPF. I must have due regard to that process. Regardless of whether people like it, that is the harsh reality.

We looked at some of the figures. Over 23,000 people are in nursing homes today and are funded by the fair deal scheme. The NTPF negotiates a rate for each of those 23,142 people. We are talking about 60 residential places within that figure of over 23,000. I am not saying for a second that any one of those 60 people are less worthy of everybody's full and total commitment and attention, but the NTPF by and large does a reasonably good job in this area. We are not in here every day debating nursing homes across the board. If we were, it would mean the whole thing was in chaos. I am just making that point to put this in context, not to take away from any of the 60 people impacted by this issue.

Senator Davitt asked for more detail regarding the negotiations. I cannot give that detail as I do not have it. I am not involved in those negotiations and do not have any input in them. If I had input and started asking about how much various things cost or how much was being spent on food, I would be breaking the law as agreed by this House and the Dáil. That is the kind of detail that goes on in those negotiations, which I cannot give the Senator.

Senator Devine-----

The Minister of State has said that they will meet again. He could enlighten us as to whether the negotiations are under way, or if he is very hopeful-----

Senator Davitt had an opportunity to make his point during his contribution.

The good Senator over here has told us that-----

-----all they wanted to hear was that it was going to-----

I could not agree more with Senator Devine about day-care places and the need to support them as a preventive model which would keep people out of nursing homes. I was with my own mother in a day-care centre yesterday. They are fantastic and are absolutely out of this world. They involve nurse-led care. Not enough people know what day-care places actually entail. There is a nurse in charge and nurses provide podiatry, physiotherapy and dietetic services. They are fantastic places. The longer people avail of such services, the more people do so, and the more such places we provide, the less likely it is that people will require long-term nursing home care. I accept the broad context of the Senator's point and support her 100%. That is not to take away from the debate we are currently having.

Senator Richmond said that this is not only about negotiation but about resolution. Both I and the Minister for Health agree with him, but we have to respect the process laid down by law. We share the House's desire for a resolution, because it does not bring either the Minister or me any satisfaction to think that there are families out there tonight with a question mark over their future. That is not acceptable. No family or loved one who is resident in one of these homes should be in such a situation. We have a vested interest in this and are 100% with the Senator in wanting this to be brought to a conclusion as quickly as possible.

Senator Boyhan acknowledged the staff, which I echo. A fantastic ethos has been developed by the staff in both St. John of God Hospital and across the country who care for the elderly. That must be recognised in every single debate. I welcome Senator Boyhan highlighting that fact.

Senator Humphreys raised a number of issues external to today's debate which I will not go into. I am happy to come back here on any occasion-----

The point is that those are the issues.

I did not interrupt the Senator, so if he would not mind letting me finish-----

I cannot let Members back in unless they wish to raise a point of order.

I am quite happy to come back to the House if Senators want a wider debate on the NTPF, nursing homes and levels of care. We face a particular challenge of which this issue is probably a symptom. I want to get to the cause as I cannot go into detail on individual symptomatic cases such as this one. This is about a negotiation between a State body, namely, the NTPF, and St. John of God.

I want to raise a point of order.

The Senator can do so when I am finished.

It is up to the Acting Chairman whether to accept a point of order. The Minister of State said that he cannot go into it. The report in question specifically related to the cost. The point of order is that the statement said the doors would not close. Based on what the Minister of State is saying, what the Minister for Health, Deputy Harris, said misled the Dáil.

That is not a point of order.

Is the Minister of State saying that the Minister for Health misled the Dáil?

That is not a point of order, and Senator Humphreys is well aware of it.

It is a point of order because these things are all related in setting the cost. It is not just about the individual but about the whole system.

I am ruling that it is not a point of order.

If the Senator had the manners to let me finish, I would have addressed those points. I ask him to please let me finish.

The Minister of State is to speak without interruption.

The Senator raised a number of issues that are separate to this matter, but one particular issue does arise here.

I am referring to the lack of flexibility in the system to acknowledge increased levels of care and this is where the difficulty arises. I am acutely aware that some nursing homes and care providers go above and beyond the call of duty. They do not just provide the standard level of care, they provide seriously enhanced levels of care. However, we have a standardised model of allocating funding to care homes that does not incentivise organisations. I am not speaking about a particular organisation, I am making a general point that the model does not incentivise carers and providers to up the level of care. We need to build in this flexibility.

The challenge we have is to build in more flexibility, tiers and levels into the payments to nursing homes based on the level of care. I have been trying to get this into the system and have had numerous meetings with Nursing Homes Ireland on it. If a nursing home goes way above and beyond the call of duty in providing activities, engagement, patient care and allied healthcare we have to have a way to fund it. A single assessment tool model is badly required. I communicated with the Secretary General of the Department this week about the urgent need for a single assessment tool so we can start building those blocks.

To move away from this debate, I do not know whether anybody in the House is familiar with what is provided for dementia patients in Bruff, County Limerick. It is very difficult to make ends meet there under the NTPF restricted model. The system does have this challenge that I must deal with and we are trying to deal with it. This is a symptom of the challenge that exists in the system.

I do not have the power to negotiate so I cannot go into detail on this and we must respect the ongoing process. There are two sides to it. I reiterate there are 430 nursing homes and care providers in the same process and they are not arising as an issue. We must acknowledge this, and that the NTPF is doing its job, notwithstanding this challenge.

That concludes the statements on services at St. Joseph's in Shankill and I thank all colleagues for their contributions.

When is it proposed to sit again?

Maidin amárach ar 10.30.

The Seanad adjourned at 6.05 p.m. until 10.30 a.m. on Wednesday, 13 November 2019.