Mr. Stephen Mulvany:

I apologise if the committee has already covered some of Deputy Murphy's questions. The Deputy asked about the value-for-money review and the publication date. I believe the Secretary General dealt with that question. The Deputy also asked about publication of the public cost-of-care rates. The HSE published in 2018, 2019 and in February 2020. There was an issue in 2018, as referenced in the report, when there was a 3% difference caused by pay rates. The rate that was being used was different from the rate that was published. The key point, which is set out clearly in the Comptroller and Auditor General's report, is that has no bearing and had no bearing on the actual contribution that individuals had to pay. They were not impacted by that.

Reference was made to a single financial system. I think there is some confusion there. There is a system that our nursing home support officers use to gather and process applications and payments for the fair deal scheme. That is a single system, although we are working to make improvements to it and we have made some improvements to it and the processes. Separate from that, there is a reference in the report to the HSE's own finance and procurement system. The HSE is implementing a single national system and that will take some years. We would expect 80% of the entire public health system, including large voluntary organisations, to be covered by 2024. These are two separate but related elements. While this is, as the report states, causing some additional complexity in calculating costs of care, it does not impact of the rates that individuals are contributing to their care. We have implemented processes to try to improve that, pending the single national financial system. That will make it more straightforward but there are other issues that my colleagues have referred to, including the safe staffing framework and the assessment of complexity, which are as important as the issue of the cost piece of it. The value-for-money report will provide an opportunity to bring those matters together and to actually see what are the structural reasons public and private might be different. The issue of the rural piece has a relevance, but staffing related issues and the complexity of care will be the predominant factors.

We make no apologies for the fact that we have public servants running these units. They are on public sector terms and conditions. In some cases, we have a different ratio of staff to patients than in private centres. In some cases, this is clearly appropriate given the dependency levels. We also have different ratios of qualified nursing personnel to unqualified healthcare assistant personnel. Typically, we have different clinical supervision at nurse management levels, which is also important.

The value-for-money report is the best opportunity to use real data to say which of those disparities are justifiable and should continue, and if there are any on either side that need to be worked on.

I will leave it there unless there are any obvious points I have missed.