I must now deal with a postponed division relating to challenges facing the childcare and nursing home sectors. On Thursday, 9 May 2024, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.
Challenges Facing the Childcare and Nursing Home Sectors: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Marian Harkin on Thursday, 9 May 2024:
That Dáil Éireann:
notes that:
- quality, accessible and affordable childcare and nursing home services are an indispensable part of the fabric of any well-functioning society, and these services support individuals and families at different stages of their lives, but most especially at both ends of life when they are in greater need of care;
- services like childcare and nursing home care are mandated by the State to operate with a certain ratio of staff to each individual accessing the service, and this has led to a situation where there is a steadily increasing cost base while incomes are not keeping pace;
- the trend towards the closure of smaller local childcare services and smaller nursing homes, which are often family run, leads to significant difficulties for individuals and families in accessing essential services locally, and also leads to regional inequalities in the supply of these services;
further notes that, in the case of the childcare sector:
- Tusla (the Child and Family Agency) data shows that 106 Early Learning and Care services closed between January and August 2021, a total of 113 closed during the same period in 2022, and 86 closed during the same period in 2023, representing an average of just over 100 closures per year and the vast majority of these closures were in small- and medium-sized services;
- the introduction of core funding combined with the high level of inflation and the freezing of fees has resulted in many service providers coming under severe financial strain;
- this situation has been exacerbated by the fact that new entrants to the market, often larger providers, do not have to comply with any cap on fees and can still avail of the same level of core funding as established providers, which leads to an anti-competitive business environment;
- the introduction of the Core Funding Chart of Accounts (CFCA) financial reporting requirement has placed a heavy and unnecessary administrative burden on managers and providers, and it has also placed a severe financial burden particularly on smaller providers whose profit margins are unable to sustain the significant extra costs involved;
also notes that, in the case of nursing homes:
- if the Health Service Executive (HSE) forecast for capacity requirements for 2031 is to be met, a further 11,000 beds are required in the sector, and yet, despite these forecast capacity requirements the spend on the Fair Deal Scheme as a proportion of overall health expenditure has steadily declined over the last decade;
- the Economic and Social Research Institute (ESRI) report entitled "Long-term Residential Care in Ireland: Developments since the onset of the Covid-19 Pandemic", published in January 2024, confirms that independently owned and operated nursing homes, many of which were family run businesses, and which until recently dominated the sector, now only supply 35 per cent of beds;
- there has been a marked shift towards a consolidation of nursing homes under larger operator groups, many of whom are recent entrants to the Irish market and some of whom are financed by international private equity;
- the same ESRI report identifies large differences in the Fair Deal Scheme funding across public and voluntary or private nursing homes, with the average price for a Fair Deal funded bed in public nursing homes being 55 per cent higher than in voluntary or private nursing homes, and this puts many private, voluntary and not-for-profit providers under severe financial pressure; and
- the ESRI identifies regional inequalities in nursing home supply and according to their research, which is based upon future planned development, these inequalities are likely to be exacerbated in the near term;
calls on the Government to put in place specific policies to ensure that in both the childcare and nursing home sectors, there will be an equitable local and regional spread of affordable quality services;
in the case of childcare services, calls on the Government to:
- increase core funding rates in line with inflation;
- ensure that the fee freeze for all childcare services remaining at historical levels must be reviewed, so that there is a level playing field between new and existing childcare services in regard to the capping of fees;
- accept the accounts that are prepared, submitted and accepted by Revenue, and not to insist on a second set of accounts under CFCA, which is proving very costly in terms of time and accounting fees, thus pushing many childcare providers over the brink;
- increase the rate of Early Childhood Care and Education funding from €69 to €100; and
- index link funding in future budgets to provide for increases to allow for new employment regulation orders for staff each year, additional staff cover due to required ratios, increased sick leave, and pension auto enrolment; and
in the case of nursing homes, further calls on the Government to:
- put in place an immediate "stabilisation fund" of €265 million to sustain local nursing home services and to stabilise the sector;
- reform Fair Deal pricing so that Fair Deal rates are based on resource allocation that reflects individual residents' care needs;
- guarantee the sustainability of the sector by ensuring a balance between the financial viability of providers, compliance with regulations covering health and social care needs, and the strategic planning of supply to meet demand across the entire country; and
- ensure equity of access to the provision of services including physiotherapy, speech and language therapy, occupational therapy and equity of access to aids and appliances for all older people, regardless of whether they are in a public, private or voluntary nursing home.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"welcomes:
— the extensive commitments by the Government to address long standing challenges in the Early Learning and Care (ELC) and School Age Childcare (SAC) sectors;
— the 72 per cent increase in State funding since the Programme for Government: Our Shared Future was published, and the achievement of the First 5: A Whole-of-Government Strategy for Babies, Young Children and their Families 2019-2028 investment target set in 2018, five years ahead of schedule, with over €1.1 billion in State funding allocated for the sector this year;
further welcomes the significant prioritisation by the Government of measures designed to:
— substantially reduce out-of-pocket costs of ELC and SAC for families;
— increase the pay and improve the conditions of early years educators and school-age childcare practitioners;
— place ELC and SAC providers on a solid, sustainable footing; and
— recognise and bolster the vital public good contributed by the sector;
acknowledges and welcomes the major achievements of the new funding model Together for Better, which brings together the National Childcare Scheme (NCS), the Early Childhood Care and Education (ECCE) programme, including the Access and Inclusion Model (AIM), Equal Start and the Core Funding Scheme, in particular:
— the roll-out and on-going enhancements to the NCS, which is providing subsidies, both targeted and universal, to record numbers of children this year, with €369 million secured in Budget 2024 to substantially reduce out-of-pocket costs of ELC and SAC to families, currently by 25 per cent on average and by 50 per cent on average from September;
— the roll-out of the ECCE programme, which enjoys uptake rates in excess of 95 per cent and has removed barriers to accessing pre-school education, with data from Growing Up in Ireland showing that more than 60 per cent of low income families would not have been able to send their child to pre-school without this programme, as well as work underway to enhance this programme, with an evaluation as a precursor to putting the ECCE programme on a statutory footing now complete;
— the roll-out of the award-winning AIM, that is supporting more than 7,000 children with a disability each year to access the ECCE programme, with preparations now being made to enhance and expand AIM beyond the ECCE programme, commencing from September 2024, where ECCE children will benefit from AIM support outside the ECCE programme hours, both in term and out;
— the introduction of Equal Start this September, a new funding model and set of universal and targeted measures to support access to, and participation in, ELC and SAC for children and their families who experience disadvantage;
— the Core Funding Scheme, with an allocation towards operating costs (pay and non-pay) of ELC and SAC providers that far exceeds the rate of inflation (i.e. €259 million in its first year and €287 million in year 2) to support the historic Employment Regulation Orders for the Early Years Services Sector, which came into effect in September 2022, providing minimum hourly rates of pay for early years educators and school-age childcare practitioners, increasing the wages of an estimated 73 per cent of those working in the sector, with proposals for a 5 per cent increase in these minimum hourly rates of pay and a proposal for the removal of the 3 year experience rule for graduate minimum pay rates recently submitted to the Labour Court by the Joint Labour Committee;
— extended support for graduate-led provision outside the ECCE programme, with almost 3,000 services now receiving graduate premiums;
— the introduction of a new fee management system in a sustainable and considered manner, which initially means no increase in fees since September 2021, which, in tandem with developments to the NCS, is delivering enormous benefits to families;
— the introduction of a requirement on services to offer the NCS to all eligible families, including sponsored arrangements, which has led to a 20 per cent increase in the number of services offering the NCS, a 52 per cent increase in the number of sponsored children and a 100 per cent increase in the numbers of children benefitting in the last two years alone, thus substantially widening access to this State support; and
— the allocation of increased funding for 99 per cent of services in year 1 of the Scheme, with no services experiencing a decrease in funding, and the allocation of substantial increases in year 2 for all services so that with ECCE capitation and Core Funding combined, services receive a minimum of €79.20 per child per week in capitation under the ECCE programme and a maximum of €95.85 per child per week with additional funding for graduate lead educators and graduate managers in the case of sessional services, and in addition to this, small and sessional services benefit from targeted measures introduced in year 2 of Core Funding at a cost of €7.2 million, specifically a flat rate top up of €4,075 for sessional-only services and a minimum base rate allocation of €8,150, and these measures saw the average allocation under Core Funding for sessional-only service increase by 30 per cent this year;
also welcomes:
— that the allocation for Year 3 of the Core Funding Scheme (from September 2024-August 2025) will increase by €44 million or 15 per cent, to €331 million, and this will support the delivery of a range of enhancements in Year 3 of the scheme to support improved affordability and accessibility for families, improved pay and conditions for the workforce and continued improvements, stability and sustainability for providers;
— the importance of the provision of validated financial returns as part of Core Funding given the scale of State investment in ELC and SAC and the importance that these data, which will underpin funding policy by Government, are comparable across all services in terms of income and expenditure components and in terms of reporting periods;
— the outcome of the intensive engagement between the Department of Children, Equality, Disability, Integration and Youth with members and nominees of the Early Learning and Childcare Stakeholder Forum, to streamline and simplify financial reporting requirements this year and next; and
— the targeted support offered to services to fulfil their financial reporting obligations under Core Funding, in addition to €32.3 million allocated under Core Funding this year for administration;
further acknowledges and welcomes the latest data from a range of sources that shows capacity in the ELC and SAC sector is growing, including:
— the latest Annual Early Years Sector Profile Survey, which shows that, between 2021-2022 and 2022-2023, the estimated number of enrolments in services rose by 8 per cent from 197,210 to 213,154;
— the Core Funding application data which shows that between Year 1 (from September 2023-August 2024) and Year 2 (from September 2024-August 2025) of the scheme, annual place hours increased by 7.4 per cent;
— the latest data from Tusla on service closures and new service registrations, which shows a net increase of 129 in the overall number of services in 2023, and a five-year low in the number of net ELC service closures, with ELC service closures falling by 18 per cent since the introduction of Core Funding; and
— the wider reform agenda underway in the area of ELC and SAC, through implementation of a range of other policies and programmes, including:
— the Building Blocks Capital Programme for Early Learning and Childcare, under the National Development Plan, that is designed to meet current and long-term ELC and SAC infrastructure needs;
— the work underway to implement the National Action Plan for Childminding (2021-2028), with a commitment to opening the National Childcare Scheme to childminders this autumn;
— the work underway to implement Nurturing Skills, the Workforce Plan for the ELC and SAC Sector (2021-2028), with commitments to develop career pathways, promote careers in the sector and support staff recruitment, complementing recent achievements, and future plans to improve pay and conditions of employment in the sector; and
— the work underway to develop an action plan for administrative and regulatory simplification for the ELC and SAC sector, informed by an independent third-party review of end-to-end processes linked to publicly funded ELC and SAC schemes/programmes and a series of regional stakeholder consultation events;
notes:
— the recent Organisation for Economic Co-operation and Development (OECD) data that shows Ireland's performance in supporting families, and particularly lone parent families, with the cost of early learning and childcare is markedly improving, even before the impact of recent enhancements to the NCS or the fee freeze is taken into account, specifically, OECD data that shows Ireland having the highest decrease in early learning and childcare costs to families across the European Union (EU) over the period 2019-2021, and that shows net childcare costs as a share of the household's net income for lone parents on low income in 2021 falling below the EU average for the first time;
— the recent report from the National Competitiveness and Productivity Council entitled 'Ireland's Competitiveness Challenge 2023', that welcomes the ongoing work by the Department of Children, Equality, Disability, Integration and Youth in this policy area and notes progress made likely to be 'a contributing factor behind the increase in female participation and our better performance in this area than many EU countries';
— the 2023 Country Report for Ireland from the European Commission which rated Ireland's progress on the County Specific Recommendation to 'increase access to affordable and quality childcare' as 'substantial'; and
— the recent OECD Country Policy Review of Early Childhood Education and Care in Ireland concluded that 'Ireland is currently pursuing a strong policy agenda for Early Childhood Education and Care, with the adoption of a long-term whole-of-government strategy for babies, young children and their families covering the period 2019 to 2028' and acknowledged that 'the country has committed itself to improving access, affordability and quality of ECEC provision'; and
furthermore, with regard to Nursing Homes, recognises and acknowledges that:
— increases in year-on-year funding for the Nursing Homes Support Scheme (NHSS or Fair Deal) will reach €1.5 billion this year;
— Budget 2023 saw over €40 million in additional funding for the NHSS, and an additional €45.6 million has been allocated to support nursing homes in Budget 2024, including a new €10 million fund to support private and voluntary nursing homes with Health Information and Quality Authority compliance;
— 2022 saw a net addition of 112 registered beds to total national capacity of private beds, 2023 saw a net addition of 490 beds to total national capacity of private beds and 2024 has seen an increase of 117 beds to date;
— a significant change the National Treatment Purchase Fund have made to their negotiation process is to offer nursing home providers contracts of a shorter duration, to ensure that rate increases stay aligned with cost pressure increases that may occur;
— the National Treatment Purchase Fund renegotiated over 300 Deeds of Agreement with nursing homes in 2023, which resulted in a 6-7 per cent average uplift, and there are approximately 400 scheduled renegotiations due in 2024, with the average uplift being 5 per cent to date, and small rural nursing homes are receiving larger uplifts on average;
— the Productivity and Savings Taskforce was established in January 2024, and the Minister for Health requested the Secretary General of the Department of Health and the CEO of the Health Service Executive (HSE) to co-chair a programme to drive savings and productivity improvements across the HSE, with a key action being to secure a reduction in the cost of care in HSE long term residential care facilities for older people, and the Taskforce will provide monthly updates to the Minister for Health;
— the Community Nursing Unit Capital Programme is successfully progressing, and as of January 2024, 48 projects have reached construction completion and construction is underway on several more facilities, and a total of €13.7 million has been made available to staff and operationalise new and replacement community beds in public Community Nursing Units (CNUs) and Community Hospitals throughout the country in 2024, and this funding will deliver 985 community beds this year (811 replacement and 174 new);
— the Government has funded a pilot for the Framework for Safe Nurse Staffing and Skill Mix in Nursing Homes Settings for Older Persons which is scheduled to conclude in 2024, and this initiative aims to develop an evidence-based framework that will determine staffing levels and skill-mix requirements in nursing homes, and which will take account of dependency levels of residents;
— over €3.2 million in State support has been provided for over 440 registered nurses in private nursing homes to obtain a Postgraduate Diploma in Gerontological Nursing, and this follows earlier similar funding provided to nurses in public and voluntary nursing homes;
— the HSE issued a directive in October 2023 to Chief Officers in every Community Health Organisation (CHO) to provide all nursing homes, both public, private and voluntary, with details on access pathways to aids and appliances within their CHO, and the CEO of the HSE has committed to ensuring that primary care services that are available to people living in their own homes will be equally available to people living in nursing homes, both public, private and voluntary, with the Department of Health collaborating on this initiative; and
— this year, a new community-based mobile X-ray service has been made available to residents in nursing homes and CNUs nationwide, and this is a free, community-based service available to all residents and follows a successful pilot.".
- (Minister of State at the Department of Health, Deputy Mary Butler)
Amendment put:
The Dáil divided: Tá, 66; Níl, 47; Staon, 0.
Tá
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Collins, Niall.
- Costello, Patrick.
- Coveney, Simon.
- Creed, Michael.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Humphreys, Heather.
- Kehoe, Paul.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McEntee, Helen.
- McGrath, Michael.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Smith, Brendan.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Clarke, Sorca.
- Collins, Michael.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Funchion, Kathleen.
- Gannon, Gary.
- Gould, Thomas.
- Guirke, Johnny.
- Harkin, Marian.
- Kelly, Alan.
- Kenny, Gino.
- Kenny, Martin.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- McGrath, Mattie.
- McNamara, Michael.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Mythen, Johnny.
- Nash, Ged.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Duncan.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Marian Harkin and Michael McNamara.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to.
The Dáil divided: Tá, 66; Níl, 47; Staon, 0.
Tá
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Collins, Niall.
- Costello, Patrick.
- Coveney, Simon.
- Creed, Michael.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Humphreys, Heather.
- Kehoe, Paul.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McEntee, Helen.
- McGrath, Michael.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Smith, Brendan.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Clarke, Sorca.
- Collins, Michael.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Funchion, Kathleen.
- Gannon, Gary.
- Gould, Thomas.
- Guirke, Johnny.
- Harkin, Marian.
- Kelly, Alan.
- Kenny, Gino.
- Kenny, Martin.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- McGrath, Mattie.
- McNamara, Michael.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Mythen, Johnny.
- Nash, Ged.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Duncan.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Marian Harkin and Michael McNamara.
Question declared carried.
Cuireadh an Dáil ar athló ar 7.14 p.m. go dtí 9 a.m., Déardaoin, an 16 Bealtaine 2024.
The Dáil adjourned at 7.14 p.m. until 9 a.m. on Thursday, 16 May 2024.