Dáil Éireann díospóireacht -
Wednesday, 20 Sep 2023

Vol. 1042 No. 3

Saincheisteanna Tráthúla - Topical Issue Debate

Nursing Homes

Deputy Michael Ring

I thank the Ceann Comhairle for selecting my matter tonight. I thank the Minister of State, Deputy Butler, who at least has the manners to come in. I thank her for that. I am raising this very important issue of St. Brendan's nursing home in Mulranny. It is a tremendous facility with a wonderful reputation, opened in 1998. It is a rural based nursing home that provides many people with opportunities to remain and live in their own village. It is a not-for-profit nursing home and a registered charity but it is classified as private and is non-HSE.

Unfortunately due to rising costs, this nursing home is finding it increasingly difficult to survive. St. Brendan's nursing home urgently requires financial support from the Government. It is vital that we support community-based nursing homes. They provide tremendous service. With an aging population it is very important that beds are maintained and not closed down. St. Brendan's nursing home, along with other private, non-profit nursing homes carry out the same work as the HSE-run units with the same number of residents. The HSE units get 60% more funding than St. Brendan's nursing home and other private non-profit nursing homes. There needs to be equality and fairness in the system. We cannot let St. Brendan's nursing home close. It has been open for many years and there are many local patients depending on it. There is one patient there for 20 years. What is going to happen if that nursing home closes down? What is going to happen to that individual and other individuals who are in nursing homes in their own areas?

I might have disagreed with Dr. Jerry Cowley on many political issues but I compliment him on his role of chairman of this nursing home, dealing with all the rules and regulations for HIQA, with the beds that have been reduced, and having gone through Covid. The other big problem they have is something the Minister of State will have to deal with in respect of the HSE. Dr. Cowley spends €2,500 to go out to India and other world countries to bring in nurses. When their contracts are up, the next thing is that the HSE targets them and takes that staff away from him. The HSE can pay more, of course, because they pay out of taxpayers' money.

This nursing home is registered as a charity. I am asking the Minister of State two things tonight. St. Brendan's is getting approximately €1,000 per bed. That needs to be increased to about €1,600 to €1,700. The second and most important thing is that it is a charity. It should not be classed as a private nursing home. It should be getting the same funding as St. Fionnan's nursing home down the road in Achill which does the same job. It is another wonderful nursing home but it will be getting €1,600 to €1,800 and Dr. Jerry Cowley's nursing home is getting €1,000. It is very unfair. I am asking the Minister of State to talk to her officials and see if there is anything she can do. This nursing home is in a crisis. We have already lost 31 nursing homes since 2020 and we do not want to lose this.

Minister of State at the Department of Health (Deputy Mary Butler)

I thank the Deputy for raising this very important issue. He spoke to me about it earlier and when I went back to my office I looked up the facility he mentioned, St. Brendan's in Mulranny. It appears to be a fantastic facility for older people to age in their community.

I am keenly aware of the challenges that have been faced by the nursing home sector over the last three years. These have been exacerbated since last year by inflationary cost increases. I am delighted the Deputy raised the situation relating to voluntary nursing homes. I think he is the first person who has done so. Some 81% of nursing homes in Ireland are privately owned, about 3.5% are voluntary and 16% are in the care of the HSE and the State. The voluntary not-for-profit sector very rarely gets an outing on the floor of the Dáil, so I thank the Deputy for referring to it.

As the Deputy will be aware, budget 2023 saw an additional €180 million of funding for services for older people for winter 2022 and into 2023, building on unprecedented increases in recent years. This includes more than €40 million in additional funding for the nursing homes support scheme, NHSS, that we all know as the fair deal, which will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated. The Department of Health has regular interaction with the National Treatment Purchase Fund, NTPF. I met the NTPF again recently to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.

Other options to support nursing homes are also being explored. Those who had a scheduled renegotiation of their deed of agreement with the NTPF this year - 60% of nursing homes have renegotiated successfully - have seen a significant uplift of between 6% and 7% on their contracts. That increase will come out of the €40 million provided. In addition, homes that renegotiated their deed this year now have an opportunity to renegotiate every 12 months. Previously, it was every two or three years. We hope this will deal with the inflation issue.

The Deputy will be aware that we are in the budgetary cycle at the moment. I have had several meetings with my team in the Department and with the HSE. I will look positively at securing more funding for the nursing homes sector. I am acutely aware of the challenges small family, community and voluntary nursing homes face. They do not have the same economies of scale as larger nursing homes. We are speaking about 33 community beds in a rural area. While we have lost a lot of nursing homes, we have seen a net increase in beds, although they may not be in the areas where we need them. I take on board all the points the Deputy raised.

I acknowledge that there are variations in the cost of care across public centres and private and not-for-profit nursing homes, with public nursing homes or community nursing units, CNUs, generally having a higher cost of care. The HSE will always step in where a resident's needs are sufficiently complex that he or she cannot be cared for elsewhere in the community. The HSE needs to be equipped to deliver that kind of complex care. I recognise that private and not-for-profit nursing homes also deliver complex levels of care to residents in many cases.

The cost of care in public nursing homes is calculated annually by the HSE and implemented as part of the funding process for public units under the Nursing Homes Support Scheme Act 2009. A number of factors contribute to these higher costs including the statutory leave entitlements available to staff at public nursing homes, as well as the rate of pay within consolidated pay scales, and reductions in the number of long-stay public beds to comply with health and safety, fire regulations and HIQA compliance. Public nursing homes generally have higher nurse and other staffing ratios in place than private nursing homes.

Deputy Michael Ring

Is there anything the Minister of State can do in the short term to support this valuable asset we have in the Mulranny area? As I outlined, it is there not to make a profit but to serve the community. Dr. Cowley has a tremendous team of staff. Perhaps the Minister of State could take a trip some time to see the way the service operates. It provides meals on wheels and housing. It is under extreme pressure. HIQA has to come in and the home has to obey the same rules. Whenever HIQA visits it costs the nursing home. The number of beds has been reduced, costs are going up and it faces a crisis. Perhaps some of the Minister of State's officials will make contact with Dr. Cowley to see if there is anything they can do in the short term. I hope this can be resolved in the budget because these homes should be treated the same as public nursing homes.

Deputy Mary Butler

One of the things I am hoping to get over the line in the budget is the provision of options to support nursing homes given the often costly nature of compliance with HIQA regulations. I fully support HIQA in what it does. At the same time, when HIQA goes into a nursing home there may be issues relating to infection prevention and control, health and safety, fire safety or ligature risks for older people. Addressing those can be very costly for nursing homes. I am looking at that area to see what we can do to support nursing homes in that regard.

As I outlined, an extra €41 million was provided. Approximately 60% of nursing homes have renegotiated their deed this year. They have seen an increase of up to 7% in their contracts, which has made a significant difference. I want to do more next year. There are nursing homes which were not in a position to renegotiate this year because they had renegotiated last year and are technically excluded from the additional funding. We are looking at that as well.

I am very conscious of all the matters Deputy Ring raised and I thank him for raising them. The voluntary not-for-profit sector does a very good job. I am looking at all options. I will take on board what the Deputy said. Mayo is one of the counties I have not been to but would love to visit.

Health Services

Deputy Jennifer Murnane O'Connor

I thank the Minister of State for the opportunity to highlight the need for a primary care centre in Tullow. We have applied for three primary care centres and there has not been an update on any of them since. The first is a primary care centre in Tullow. We also applied for an injury clinic in Carlow and a primary care centre in Borris. There is a need for these centres given the growth in Carlow's population and the ageing population. Injury clinic and primary care centres are also needed to alleviate pressure on the nearest hospital in the neighbouring county.

Carlow is one of the fastest growing counties in Leinster according to the Central Statistics Office, CSO. Carlow town now has more people living in it than Kilkenny city, yet we have no hospital. We have extensive pressure on the out-of-hours service and limited use of a perfectly good X-ray facility in St. Dympna's Hospital. We need an injury clinic in Carlow to make use of the good facilities already there and to allow for the expansion of the service to properly serve the people of Carlow given our growing population and the demand on this service. Since 2016, the population of County Carlow has grown by 9% or 5,036, bringing the total to 61,968. The CSO figures indicate that the population of Carlow town is 27,351 and the population of Kilkenny city is 27,184. Carlow town's population figures include the area of Graiguecullen. The town is now bigger than Kilkenny city. That is some information for the House.

An Ceann Comhairle

Carlow city.

Deputy Jennifer Murnane O'Connor

Yes. We will have to call it that, a Cheann Comhairle. If there was a minor injury clinic in every town, it would take the pressure off all the accident and emergency departments and reduce the hours people must wait just to get an X-ray. We have a fabulous X-ray department in Carlow but it is only open part time. It is based in St. Dympna's Hospital. It is an excellent facility. I am looking for it to be opened five days a week because of the pressure on the accident and emergency department in Kilkenny. I compliment the staff in Kilkenny who do a great job.

It is also important to have primary care centres in our county towns. In April 2016, I was told the HSE proposed to deliver a primary care centre for the Tullow, Rathvilly and Hacketstown area using its own direct-build mechanism. The HSE said its capital plan would fund the centre. It has told me that Tullow was only identified last year.

I was told it was imminent, but it is still not there. This is an urgently required centre that has been promised for a long time. I have no date for its delivery. I was promised a meeting to get an update on this provision, but I still have not heard word.

When I speak about data and census figures, the county town of Borris has the oldest population in Carlow, with an average age of 44.9. It also needs a primary care centre because of all the towns in Carlow it is the most rural and spans several small townlands. It is a gorgeous part of the county. However, it is seriously under-served. Again, I have to highlight Carlow and our beautiful scenery.

Carlow urgently needs these projects because of the explosion in population. I look forward to working with the Minister of State to achieve this. We have huge issues in Carlow waiting for things. Tullow and Borris primary care centres are required. We also need an injury clinic for Carlow.

Deputy Mary Butler

I thank the Deputy for raising the issue. The question she submitted was to discuss the provision of an injury clinic in Carlow. I do not have the details on primary care centres into Tullow and other areas the Deputy mentioned. When I read her question while preparing to come to the House to discuss the provision of an injury clinic in Carlow, I realised I would also discuss the provision of an injury clinic in Dungarvan, County Waterford. We are all trying to facilitate things in our areas. I thank the Deputy for her constant advocacy for improved health services.

The national emergency medicine programme model of care recognises the need to support the development of injury units. These units provide care locally in cases where injuries are unlikely to require hospital admission. I am pleased that 15 local injury units are open around the country, each one providing an important service to their local communities. The Deputy is quite right; these units take huge pressure off emergency departments. They also play an important role in reducing the waiting times for patients in emergency departments throughout the country.

The services provided at injury units are held in high esteem by patients. This is evident by the large and growing demand for these services. Approximately 140,000 patients attended injury units in 2022, an increase of more than 30% since 2019. This represents approximately 7% of all urgent and emergency activity in Ireland.

I can advise the Deputy that the HSE has carried out a review of injury units. The review aimed to identify areas of best practice that could be rolled out across the country. The scope of this review included the review of 13 injury units nationally, as well as areas having the most potential need for additional injury units. The review considered the activity, operations and governance of these units. The HSE has advised that the review makes a number of recommendations to improve existing services at local injury units as well as outlining options for future developments. These recommendations are broadly based on two themes: the need to standardise existing services and to identify options for the future development of local injury units in the medium to long term.

All recommendations will, of course, also be subject to resource and other considerations, including alignment with the urgent and emergency care plan being developed by the HSE. I am advised that these recommendations are currently under review by the HSE and it is expected that this will inform the development of an implementation plan.

I visited the injury clinic in Bantry General Hospital about 12 months ago. I was impressed by the facility, which means that people living in that part of the country, that is, west Cork, do not have to go to the emergency department in Cork city or other hospitals such as CUH, Mercy and others. That makes a huge difference to people. I will make inquiries as to when we will see the results of the review because we have 15 local injury units that are very successful and work very well. If we could roll out more of them across the country, it would take huge pressure off our emergency departments.

Deputy Jennifer Murnane O'Connor

I want to welcome this. It is important. I welcome the review. No offence, but I will fight twice as hard for Carlow now. The Minister of State mentioned Waterford. In fairness, the Ceann Comhairle always says to me, "Carlow, Carlow, Carlow", but as a passionate lady who is honoured to work for the people of Carlow-Kilkenny, I firmly believe that an injury clinic would be important for us.

We also need clinics in Tullow, Hacketstown, Rathvilly and Borris because, given the population growth, we need to have these services for people. Such units would be a huge help to Kilkenny hospital, which provides a great service. However, it is packed to capacity at all times and can only do its best. I will fight hard for this injury clinic. I welcome the review. I also welcome the ongoing work of the Minister of State and her urgent attention on the health service in CHO 5. It is the first time ever we will have dedicated national youth mental health officer in the HSE. That is another huge achievement by her and demonstrates her commitment to deliver on mental health services.

I have asked for an injury clinic. I have tabled a question on this to the Minister for Health, Deputy Stephen Donnelly, two or three times. I will table further questions to him. I firmly believe Carlow needs an injury clinic.

Deputy Mary Butler

I thank the Deputy for her kind words. I am delighted to put on the record of the Dáil that for the first time ever in history of the State we now have a national office for youth mental health within the HSE. We never had that previously. Dr. Donal Kelly took up the post on Monday of this week. We also have the clinical lead in Dr. Amanda Burke. I hope this will pull all of the strands of the services we have together to try to make things more effective.

The Deputy mentioned Hacketstown, Rathvilly, Tullow and Borris. There is a programme in place at the moment. Primary care centres have been rolled out across the country over the past ten years. I will check the status of some of those. Obviously, it depends on population and demand in a particular area, as well as budget. We know primary care centres are very important in communities. I will check that out for the Deputy and revert to her in due course.

Childcare Services

Deputy Mick Barry

The Before 5 Family Centre in Churchfield, Cork, closed at the end of August and went into liquidation. The centre provided preschool, crèche facilities, after-school and homework facilities, play therapy and adult courses. Approximately 170 children lost out as a result of the closure. More than 100 families were affected and 14 workers, some of whom have been there for 28 years and made a valuable contribution to society, lost their jobs.

Earlier today, I had an exchange with the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman, on this issue. In that exchange, I made the point that this is a failure on the part of Government to step in and say that the Department of Education will take direct responsibility for the provision of childcare not just in Churchfield but throughout the State. I said it was a failure on the part of Government by allowing a situation whereby this type of thing happens all the time with regard to preschools and childcare in the State. There is no guarantee of continuity of service the way that there is with primary education.

I will not repeat those points. I instead want to drill down into some of the details of what happens next. A statement was issued yesterday, which indicated that the replacement facilities would not be in place until, at the very earliest, the start of next year and that would be dependent on how much work needed to be done on building regulations, fire safety, Tusla regulations and so on. That information will not be known until some time next month. Recruitment is not due to start until next year. What parents want and need to know is when the preschool and crèche will reopen in Churchfield. What are people meant to do in the meantime?

A woman tweeted the other day that she was looking for childcare facilities for her child. She has her name down for 20 services in the Cork area and cannot get a place in any of them. Some people are trying to hold down jobs.

How are they meant to hold down jobs and juggle that situation let alone the unfairness to their children? A crisis demands crisis measures.

What assistance can the Department give the new company taking over, Northside Community Enterprise, so that when building works are identified, they are not done slowly, slowly but done as rapidly as possible? Can the State step in and provide alternative childcare and preschool arrangements for the families who have been thrown into crisis throughout the northside of Cork city on this issue?

Regarding the children who were to go into Before 5 under the access and inclusion model, AIM, my understanding is this model is specific to the particular preschool and does not necessarily follow the child with the guarantee of those extra resources to an alternative childcare provider if one can be found. What can be done for these parents? It is a real crisis for them.

Deputy Mary Butler

I heard the Deputy's exchange during Questions on Promised Legislation. I am familiar with the situation having seen it in the media. I thank the Deputy for raising this very important issue. As he stated, the Before 5 Family Centre at Churchfield in County Cork was so much more than a preschool and a crèche. It was after-school, play therapy and homework clubs and was very important to the parents of the many children who attended it. I am taking this issue on behalf of the Minister for Children, Equality, Disability, Integration and Youth, so I hope I will be able to answer the questions Deputy Barry puts to me.

While it is noted the service in question has been cited in media reports, no financial or operational detail of any individual service will be disclosed in this reply. I know the Deputy did not ask for that. Northside Community Enterprise, which already manages an early learning and childcare service, is negotiating a lease agreement with the diocese to provide early learning and childcare in the building previously managed by the Before 5 Family Centre.

Northside Community Enterprise has issued a statement regarding its progress with this undertaking and has advised it is necessary to address maintenance issues and to improve fire safety requirements to fully meet all compliance obligations under building regulations, fire safety regulations and Tusla regulations before it can reopen as an early learning and childcare service. Both Cork city and county childcare committees and Pobal are working with Northside Community Enterprise and supporting it to navigate the administrative requirements and regulations in opening up a new service.

Regarding the closure, the Minister for Children, Equality, Disability, Integration and Youth is acutely aware of the difficulties this has posed for the families and children who attended the facility as well as the staff who work there. However, the Department of Children, Equality, Disability, Integration and Youth does not own or operate early learning and childcare services. These services are privately operated. The decision to cease operations of the Before 5 Family Centre is a matter for the board of the service. It is not within the remit of the Department to discuss specific issues of individual service providers. Pobal and Cork City Childcare continue to work on behalf of the Department to support parents to find suitable alternative quality early learning and childcare for their children following this closure.

Deputy Barry asked about when we can expect to see the new service. As indicated previously, Northside Community Enterprise is in the process of completing its compliance obligations before opening. These compliance regulations are to ensure the safety, health and well-being of children and ensure quality of provision. When the different agencies with responsibility for these regulations are satisfied that the service is compliant, the service will open. Cork City Childcare is available to support the service to navigate these requirements.

I am not in a position to answer the question about AIM but I will follow it up for the Deputy. The Department of Children, Equality, Disability, Integration and Youth, through the city and county childcare committees and Pobal, provides sustainable supports to all early learning and childcare services experiencing difficulties and through which sustainability funding may be granted should the need arise. This can include help for services with completing and interpreting analysis of staff ratios and cash flow as well as more specialised advice and support appropriate to individual circumstances. In some instances, financial supports through sustainability funding may be appropriate in tandem with this case management process.

Deputy Mick Barry

The key sentences in the Minister of State's reply are, "However, the Department of Children, Equality, Disability, Integration and Youth does not own or operate early learning and childcare services. These services are privately operated." In reality, the Minister of State is saying we have a significant crisis on the northside of Cork, 100 families have been left without childcare, people are trying to manage this situation, hold down jobs and cannot get into other childcare facilities, and the State does not take direct responsibility for resolving the situation. This is the reason childcare and early learning in this State needs to come under the remit of the Department of Education and needs to be directly provided by the State so that the situation that pertains in primary education, where we do not have a crisis every August and September over a primary school being up in a heap but there is continuity of service, will apply to preschool as well.

However, I cannot let the Minister of State off the hook. The State has a responsibility here and Government TDs in particular will be watched very carefully by parents. Elections are coming up next year. How do they respond to this? There needs to be an intervention by the Department and the State to ensure whatever building changes happen in Churchfield are done rapidly and every assistance is given. I will continue to put the pressure on for alternative childcare arrangements. This crisis is not going to go away for those families.

I welcome that the Minister of State said she would get back to me about AIM. The children of people who have it need access to it if they get into another facility. If necessary, special measures need to be put in place for those situations. Those 14 workers are hugely valued by the community and I will be watching like a hawk to see they get their jobs back and can continue providing that service.

Deputy Mary Butler

The Department monitors availability of early learning and childcare on an ongoing basis with a particular focus on responding to the unmet early learning and childcare needs of families. The most recent data on availability shows that, on the whole, supply for early learning and childcare is meeting demand, although there are pockets of undersupply in certain areas and for cohorts of children, particularly babies and toddlers. Cork city and county childcare committees are in a position to support children and families to identify services operating with vacant places. The childcare committees also engage proactively with services to explore possibilities for expansion, especially where there is unmet need. Both Pobal and Cork City Childcare continue to work on behalf of the Department to support parents to find suitable alternative quality early learning and childcare for their children following this closure.

I understand how upsetting it is for the families. Their children are used to a facility. The Deputy also mentioned the 14 staff who are present. I will follow up tomorrow regarding AIM and whether it is specific to the Before 5 Family Centre or whether it carries forward.

Cuireadh an Dáil ar athló ar 9.40 p.m. go dtí 9 a.m., Déardaoin, an 21 Meán Fómhair 2023.

The Dáil adjourned at 9.40 p.m. until 9 a.m. on Thursday, 21 September 2023.