We are facing a crisis in the nursing home sector because 16 private nursing homes have already closed this year and 450 beds are gone. Unfortunately, too many owners are at their wits' end in reassessing their current financial position.

The escalation in the cost of energy and the cost of living is certainly a factor, but the underlying cause is the fact that the fair deal funding model is not fit for purpose. This is not something we are only discovering now. It has been flagged time and again in many different reports. There were two from HIQA, one from the Comptroller and Auditor General, one from the Department of Health and one from the Ombudsman.

HIQA's latest report states:

HIQA believes that the closure of small nursing homes should be considered in the context of the loss of a particular model of care and not just in terms of bed numbers. Smaller nursing homes that are embedded in the local community offer person-centred care in a very homely environment. Their closure sometimes means that older people in need of residential care have to travel further in order to receive care. This has a knock-on effect for residents, particularly in terms of visitors, social activities and links to their preferred GP or pharmacy.

The fair deal model is structured in such a way that private nursing homes receive in the region of €600 less per person per week, which is an incredible difference. In January 2022, the average fee payable under fair deal for a HSE nursing home was €1,674 per person per week and €1,047 per person per week for private and voluntary nursing homes .

When I raised this with the Tánaiste previously, he suggested that public nursing homes often deal with people who have more complex care needs. While this may have some validity in a restricted number of cases, it is not the universal situation and cannot explain the considerable difference in payments between private and public nursing homes. An urgent review of the pricing model is needed.

It is also important to remember that nursing homes are a vital link in our health services at all times but especially now when our acute healthcare system is under such pressure. It makes no sense that we are allowing nursing homes to close when our acute hospitals have ever-lengthening waiting lists and people waiting on trolleys and in emergency departments. The Taoiseach can fix this almost overnight. He should put in place a sustainable fair deal model because nursing homes are a vital link in the healthcare chain and that chain is at breaking point.

There has been huge expansion in the nursing home programme over the years, particularly in terms of the nursing home support programme. Approximately 80% of all nursing homes are private and 20% are under the HSE, which we call community nursing units. The State is allocating approximately €1.4 billion per year to support approximately 22,000 nursing home residents and that has seen a strong increase over the past two years in particular.

During Covid-19, an additional €144 million was allocated to nursing homes. That cannot be dismissed. It was a significant intervention by the State, correctly, to underpin nursing homes in respect of the challenges that Covid-19 undoubtedly presented to them. All Deputies know the details of that intervention.

The cases of residents in community nursing homes are more complex. We should not dismiss the difference. The cases are more complex by definition and there are more staff in community nursing units. That said, we acknowledge the issues and challenges because the private nursing home sector is going through some change, with regard to financial underpinning of larger nursing homes, in the sense that large organisations are coming in and smaller and community-based nursing homes are feeling the pressure. That is acknowledged and we accept it.

That is why a significant package is being discussed and will be implemented, the announcement of which is imminent, for nursing homes to deal with the inflationary cost increases they are experiencing. Substantial funding is being made available to the Minister of State at the Department of Health, Deputy Butler, to do so. Discussions have been taking place with nursing home organisations. It will help to deal with the inflationary pressures that nursing homes undoubtedly face. The temporary assistance payment scheme will also continue to the end of the year.

There have been a number of reviews of the pricing mechanism and that is the subject matter of negotiations. The National Treatment Purchase Fund, NTPF, under legislation that was passed quite a number of years ago, is the body delegated to arbitrate on price for nursing homes. An outcome is also imminent to get that resolved. We acknowledge that needs resolution but legislation passed in this House has ordained that be done through an independent mechanism, namely, the NTPF.

Changes are going on in the dynamic within the private nursing home sector and senior care. The allocation to home-based care will grow and the nature and duration of stay or residency in a nursing home will change in the time ahead.

I acknowledge what the Taoiseach said in that there are various initiatives in the pipeline but two nursing homes closed in County Roscommon and one closed in Athlone, County Westmeath last week. The lady was on RTÉ and the figures are public knowledge. She said that her nursing home received €950 per person per week but the local public nursing home received €1,915 per person per week. That is not tenable. No private nursing home could survive that black hole in funding provision.

The Taoiseach spoke about money given during Covid, which was most welcome, but we all remember the considerable restrictions and challenges and every cent of that was needed to deal with Covid. It did not deal with the underlying problem, namely, the funding mechanism under fair deal. I hope what I heard the Taoiseach say is that the initiatives he is now looking at will begin to deal with that. According to its most recent report, HIQA believes that the closure of smaller nursing homes requires urgent attention to avoid further closures impacting on the lives of residents, their families and friends. That is from HIQA; it requires urgent attention.

As the person who set up HIQA, I take its guidance seriously. It has been very effective in increasing standards in health in this country since its initiation in the early 2000s. We take its point of view seriously because we want to protect and do everything we can to support smaller nursing homes as well because they are important in local communities for obvious reasons such as proximity to families and so forth.

It is important, therefore, that we do whatever we can to underpin nursing homes. I get the sense that since Covid-19, State underpinning of nursing homes is growing. It was a very significant intervention during Covid in addition to the nursing homes support scheme itself. We have a significant inflationary package coming in before the end of the year to support nursing homes to get through the energy crisis. Then there is the issue of the pricing arrangements, which are set by the NTPF, in terms of increasing those or at least having a serious discussion. There have been a number of reviews undertaken here so it is not as if people do not know there is work under way, because there is, on trying to get the right formula that would make ends meet for the nursing homes concerned.