Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

I thank the witnesses for their submissions and the work they are doing on these cost-benefit and value for money analyses. There have been questions comparing public and private provision already. Between 2010 and 2018, the cost of public nursing home provision has increased by 26% where the private sector has increased by 11% in that period. The 2018 figure was €1,564 in public and €968 in private. The €1,564 is to cover the day-to-day running costs of a public nursing home where the €968 which the private nursing home collects includes part of the repayment for the capital cost. It is only a small part but the private sector has to pay for the cost of providing the building whereas in the public sector, that is absorbed into the HSE budget. Therefore the discrepancy is far higher. Why was there a 26% increase in public sector costs in the eight-year period and an 11% increase in private sector costs?

From the report, the HSE indicates that the total operating cost of public nursing homes for 2018 was around €590 million. A total of €320 million was from the fair deal scheme and €68 million from residents' contributions. Can I get clarification on that?

Another member raised the matter of dependency. When someone goes into a private nursing home, he or she may be able to get up and walk around, but as the years pass, that person's dependency increases. Is there a review of that dependency and is it built into the cost that the private nursing home must accommodate? There is a change from the first day a person arrives in and, say, three years later.

Can we get a better system for step-down facilities? If we want to develop home care, we must have step-down facilities. We find time and again that someone who is in a hospital and ready for discharge after five days is still occupying a bed six weeks later in the same hospital. What is being done to develop step-down facilities? What can be done immediately to do that? It is the biggest cost factor in the HSE. Recently, I dealt with someone who had a stroke and was still occupying a hospital bed 16 weeks later even though they were ready for discharge.