I welcome back the Minister. I raise with him the critical situation currently being faced by many private and voluntary nursing homes. They provide care for more than 25,000 people in more than 400 locations and provide 80% of all nursing home care. Yet, 31 private and voluntary nursing homes have closed over the past three years with the loss of 915 beds. The crucial issue is that these closures have primarily been located in regional and rural areas. Furthermore, the trend is worsening because 19 of those 31 closures have occurred in the past 12 months. What the figures do not tell us is that many more small to medium-sized nursing homes, many in my own constituency, are hanging on by a thread. We know why this is happening. Report after report from HIQA and others, including the latest one from PwC last February show that private and voluntary nursing homes receive approximately €600 less per resident per week than their HSE counterparts. That is worth repeating - some €600 less per resident per week. If you had a 40 bed facility, that would be about €1.25 million less than a similar HSE facility under the fair deal scheme.

I am telling the Minister that is unsustainable and that is why they are closing. Private and voluntary nursing homes operate under exactly the same criteria and the same regulations as HSE facilities, and rightly so. They provide a level of care that is identical. Will the Government provide an immediate stabilisation fund of €190 million in the next budget to help ensure their short-term viability and help prevent further closures? I also ask that the fair deal rates be reviewed and reset to reflect the real cost of elderly care. Many nursing home owners in my constituency have told me they are under severe financial pressure. I cannot name them, because that would immediately cause huge upset and concern for families, residents and staff.

What I do not want to see is their names being added to the ever-growing list of closures. Will the Government stop dragging its heels and deliver some level of equity and fairness in this sector both for the residents and for the staff who work there?

I thank the Deputy for raising this important issue. I have also had a nursing home in my own constituency under an awful lot of pressure. It puts huge strain on families as well when they do not know what the future holds in terms of whether the nursing home is going to stay open.

The Government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes. They may not have access to the same economies of scale as larger homes or groups. As the Deputy knows, the Government has provided substantial support to the private and voluntary nursing home sector over the pandemic period. Over €151 million of financial supports have been provided to private and voluntary nursing homes through Covid-19 temporary assistance payments. The provision of free personal protective equipment and oxygen to private nursing homes continues, costing approximately €77 million to date. A new €10 million scheme was established last year to support private and voluntary nursing homes with increased energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home. This scheme was extended for a second time to the end of June 2023 with a further short-term extension under review.

The Minister of State, Deputy Butler, has regular interaction with the National Treatment Purchase Fund, NTPF, and has met it to discuss ways to support the sector where necessary and appropriate to complement the normal process of negotiating rate increases when contracts are renewed. Anyone who has had a scheduled renegotiation of his or her deed of agreement this year with the NTPF has seen a significant uplift, an average baseline increase in price per bed of between 6% and 7%. From what the Deputy is saying, that is not enough for some nursing homes but it is important to put it on the record. Other options to support nursing homes are also being explored, such as to help with the often costly nature of compliance for nursing homes under the necessary Health Information and Quality Authority regulations.

Ensuring that the welfare and safety of residents is secured when nursing homes close is of course of the utmost importance and work to alleviate the concerns of residents must continue. Fourteen private nursing homes closed last year while nine private nursing homes have closed so far this year. A further two private nursing homes which are currently active have notified closure for this year. Four new centres opened last year and four new centres have already opened in 2023. As of the most recent HIQA report up to the end of June, overall 2022 saw a net addition of 112 registered beds to the total national capacity of private beds, while this year we have seen an increase of about 222 to date. This is due to the relatively large size of the new nursing homes compared with those closing, which have less capacity.

I recognise the point the Deputy is making. For many smaller nursing homes in more rural parts of Ireland, they do not have the economies of scale and cost base that some of the larger nursing homes and groups have. The concern the Deputy is outlining is that this needs to be reflected in the support the Government gives them. I take on board what the Deputy is saying and will certainly raise it with the line Minister. There are different rates applying depending on different circumstances. What the Deputy is suggesting is that the deviation is not wide enough.

I thank the Minister. He did talk about substantial support but he said it himself, that was pandemic support. It was for Covid only. It did not deal with the systematic inequity in the fair deal system. The Minister talked about a 6% or 7% increase, yet the difference in support between the two types is of the order of 60%. It is not enough. I could not name a nursing home in my own constituency but I can name St. Brendan's nursing home in Mulranny. Its situation is dire and it is now in the public domain. I spoke to my colleague, Dr. Jerry Cowley, who along with people from the local community set up St. Brendan's 25 years ago as a not-for-profit nursing home. They are struggling. They have spent hundreds of thousands bringing the nursing home up to the proper fire regulations and room size regulations, and rightly so. They receive €600 less per resident than the HSE facility nine miles down the road. They provide the same level of care.

When they source staff from abroad, two years later the HSE takes on their staff because it offers them better pay and conditions. They are in impossible situations. I want to know what the Government is going to do for nursing homes like the one in Mulranny. I accept that four new centres have opened, but they will not open in Mulranny and they will not open in smaller regional and rural areas. That is the crucial issue.

As the Deputy knows, private and most voluntary nursing homes agree the price that they can charge for a fair deal resident with the designated State agency, which is the NTPF. This is not a political negotiation. It is done by a State agency that is there to do that. Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF's cost criteria such as costs reasonably incurred by the nursing home, local market prices, historical prices that have been paid and overall budgetary capacity. A significant change that the NTPF has recently made to its negotiation process is for nursing home providers to agree a shorter contract duration of 12 months. This aims to ensure that NTPF rate increases stay aligned with any cost pressure increases that occur over the course of the contract period. In other words, I think there is a recognition in the system now that we have had a lot of disruption in terms of costs and a lot of increases that have happened at short notice. This has impacted disproportionately on a lot of smaller nursing homes and the NTPF negotiation process is now trying to respond to that appropriately.