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 Header Item Childcare Services (Continued)
 Header Item Nursing Home Services

Thursday, 4 April 2019

Dáil Éireann Debate
Vol. 981 No. 5

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(Speaker Continuing)

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

Deputy John McGuinness: Information on John McGuinness Zoom on John McGuinness I have already written to the Minister about this matter.

An Ceann Comhairle: Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl Perhaps the Minister and the Deputy could have a chat.

Nursing Home Services

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

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

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

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

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

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

Minister of State at the Department of Health (Deputy Catherine Byrne): Information on Catherine Byrne Zoom on Catherine Byrne I am taking this question on behalf of the Minister of State at the Department of Health, Deputy Jim Daly.

An Ceann Comhairle: Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl The Minister of State should be appointed "Minister for Topical Issues".

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

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

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

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

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

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