I received number of emails recently regarding the severe difficulties being experienced by private nursing homes in recruiting and retaining staff, especially healthcare assistants. This issue is especially acute in small, rural nursing homes. The simple reality is that private nursing homes are not able to match the HSE in the context of pay and benefits, as well as, recently, more aggressive recruitment by the HSE and HSE-funded agencies. This is placing intolerable pressure on private nursing homes.

I am a strong supporter of home care packages and I believe that we need to invest significantly in that model of care. For many different reasons, however, we will continue to need the very important services of the nursing home sector. I am not in the business of trying to increase profits in the sector. My objective is to try to ensure decent wages and proper benefits for staff as well as an accessible, affordable and quality service for those who need it.

I have no ideological bias between private or public care. I want a quality service, fit for purpose, which represents value for money. On the issue of value for money, the Comptroller and Auditor General published a report this year on the fair deal scheme. That report states that the weekly average fee in 2018 for public nursing homes was €1,564, while for private nursing homes, it was €968. As care standards overseen by HIQA are the same in all nursing home settings, this means the staff in private nursing homes bear the brunt when it comes to cost savings because the homes have to make a profit, otherwise they close their doors. This is completely unacceptable. In July 2016, the Tánaiste, then Taoiseach, published the terms of reference for a review of the fair deal scheme. That report remains unpublished. Why is this? Will the Tánaiste publish it now, or will he ask the Minister for Health to do this?

The report from the Comptroller and Auditor General stated the National Treatment Purchase Fund, NTPF, which is responsible for the determination of fees under the fair deal scheme on behalf of the State, did not provide his office with a model to inform how the fee is determined under the fair deal. There is no clarity on the models of funding. If the scheme is called "fair deal", it should be a fair deal for all involved - the residents, the nursing homes and the staff who work there.

I have looked at the programme for Government and I am not excited by what I see. What proposals can the Government bring forward to ensure the sustainability of this sector?

I thank the Deputy for raising this important issue. Like her, I think there will always be a role to play for nursing homes. We want more home care and more people being able to stay in their homes for longer and that is the plan and the direction of travel. This is why so much additional funding has been provided for home care in recent years with a 40% increase in the past couple of years and a further increase next year. There will always be people who need a nursing home and who need residential care and this needs to be provided for. Like the Deputy, I have no ideological bias as to whether that is provided by the public or private sector, so long as standards are high and that people are cared for properly.

On the fair deal review, I had thought that was published ages ago. I may be wrong. If it was not, I will check into that.

The fees paid by the State to the nursing homes under the nursing homes support scheme are negotiated between the NTPF and nursing homes individually and that is done on a confidential basis because it is commercially sensitive. The NTPF tries to make sure that reasonable costs are covered and that a reasonable profit is possible for those nursing home providers.

It is difficult for private nursing homes to compete with the State and with the HSE for staff. This is because in the State sector the pay is generally that little bit better and there is the possibility of a public sector pension, which is very valuable, and the leave arrangements can also be beneficial. We need to bear in mind that the nursing home sector is very profitable. I know that this year may have been an exception but, in the round, the nursing home sector is profitable. It may be the case that there are a lot of nursing homes around the country that have the capacity to offer better terms and conditions for their staff by reducing their profits. We need to be frank about this too.

There is a difference between public and private nursing homes. They are not directly comparable. It is generally the case that those public nursing homes under the HSE tend to care for people with higher care needs. We often see figures comparing one sector with the other and saying that the cost of providing care in a HSE nursing home is higher than that in a private nursing home. This is often because the public nursing homes tend to take people with higher care needs, so it is not always directly comparable in the way some people try to compare it.

I thank the Tánaiste. I hear what he said and he made some valid points. When the former Minister for Health, Deputy Simon Harris, addressed the Nursing Homes Ireland annual conference last year, however, he spoke about the changes in regulations and said that these changes had been "stressful" and "have come at a cost and you haven’t been remunerated for that cost." The Tánaiste's own former Minister for Health has recognised this. In my constituency in Sligo, public nursing homes cost 60% more; in Leitrim, 68% more; in Roscommon, 76%; and in Donegal, 81% more. I spoke to nursing home owners who said that especially in the context of Covid-19 their income has dropped. They, rightly, had to go from double rooms to single rooms. Their income has not dropped by 25% or 30%, however, so they have not been able to access State supports such as the employer wage subsidy scheme or the restart grant. They have had help with personal protective equipment, but it is proving especially difficult. The Tánaiste is correct that we do not want a model where enormous profits are made in the sector on the backs of workers but we have to find a way that the smaller rural nursing homes in particular remain sustainable and provide that service.

The Government acknowledges that nursing homes have been badly affected by Covid, that income is down and that costs are up. In response to that, we established a Covid-19 temporary assistance payment scheme. That was set up back in April. Applications opened on 17 April. The core concept of the scheme is that the State will provide additional funding to nursing homes that require it to contribute to their additional costs associated with Covid-19, and to the costs of dealing with mitigation and outbreak management where that occurs. Eligible costs include both additional payroll and non-payroll Covid-19-related costs. The scheme was originally to operate only for three months to the end of June but it was extended to the end of September. The scheme is now being further extended to the end of 2020 and for the first six months of 2021. This additional funding will run through at least until the middle of next year.

I appreciate what the Deputy said about smaller nursing homes, especially in rural areas, which because of their scale may have higher costs. This needs to be taken into account also. If she has individual cases she would like the Minister or me to look into, to the extent that we can, we would be happy to do so.