Mr. Robert Watt:

Good morning Chair. It is good to see you again. I thank you for the invitation to meet to discuss the issue in relation to nursing homes. I am joined by colleagues who you have mentioned.

The nursing homes support scheme currently supports more than 22,500 residents in approximately 550 nursing homes across the State. Funding of €1.1 billion has been provided for the scheme in 2023. The scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. It provides a universal and transparent system of support that is fair to all, irrespective of whether they are in a public, private or voluntary nursing home. Participants contribute to the cost of their care according to their means, while the State pays the balance of the cost.

As members are aware, prior to the introduction of this scheme in 2009, separate arrangements existed for funding public and private nursing home care. Up to 2009, people who were provided with publicly funded long-stay care in public facilities and in publicly contracted beds paid a contribution towards the cost of their maintenance through a charge. These charges were raised under regulations made in 1954 and 1976. The majority of the cost of public nursing home care was funded by the State through the health budget at that time.

The situation with private nursing homes, as members are aware, was different. People entered into contractual arrangements with these homes and were responsible themselves for meeting the costs of the fees. This included people who were assessed as fully eligible under the Health Act 1970 and had a medical card. The State provided financial assistance towards the cost of fees through a subvention scheme. It was accepted in 2004 that there was a flawed legal basis for raising charges on those with full eligibility in publicly funded care. This was regularised by the introduction of legislation in 2005 to provide for charges in publicly funded care and the establishment of a repayment scheme to refund charges that had been paid pre-2005. The scope of the repayment scheme was well publicised at the time.

It is a matter of public record that people who paid fees in private nursing homes have taken legal cases on the basis of claims that the State failed to provide nursing home care in private nursing homes free of charge to those who had full eligibility under the Health Act 1970. Cases have been managed by the Department of Health on a case-by-case basis in close consultation with the Office of the Attorney General. The consistent position has been that it was not the policy intent of Government at that time for public moneys to be used in this way, and that eligibility under the Health Act 1970 was and continues to be subject to the availability of resources. This matter has been the subject of significant discussion over the years. It is important to state that it is well accepted that the previous dual system of funding for public and private nursing home care was unfair. Thankfully, the nursing homes support scheme now provides for a fairer system of support for all.

I would like to address related issues that have arisen in relation to payment of contributions towards maintenance in residential disability services. Similar to the position on nursing homes, it has been the long-standing policy position that it is fair and reasonable that people should make some contribution to the cost of their long-term care, and that such contributions from residents’ income towards household expenses is in keeping with the mainstream policy of supporting people with disability to live ordinary lives in ordinary places.

In circumstances where long stay inpatient charges were not levied on residents in disability facilities, residents may have made contributions towards household expenses if they had means. These contributions were not raised under the 1954 or 1976 regulations, which were subsequently found to be ultra vires. They were therefore not comprehended within the 2006 health repayment scheme. Claims were made for repayment of these contributions by, or on behalf of, residents in some of these facilities under the health repayment scheme. These claims were rejected by the scheme administrator on the basis that they were not within the scope of the scheme. Appeals to this decision were taken, and the independent appeals officer determined that contributions made by residents of a number of institutions should be repaid under the provisions of the scheme. The rationale for this decision was related to the specific contract that these organisations had with the relevant health board for inpatient services.

The Department of Health and the HSE originally appealed these decisions to the High Court, but the appeal was subsequently withdrawn, and repayments did issue in respect of these cases. The decision to withdraw this appeal did not change the position of the Department that voluntary contributions did not come within the definition of recoverable changes set out in Health (Repayment Scheme) Act 2006.

This matter is complex, and Deputies on the Committee of Public Accounts have raised questions with me and colleagues in respect of this. I believe it requires further examination. It will require further engagement with the HSE to enable a better understanding of the situation, and I have written to the HSE in this regard this week. It will also require engagement with the Office of the Attorney General. This work will be comprehended within the broader examination of matters raised in recent weeks, with the agreement that the Minister for Health, Deputy Stephen Donnelly, will revert to Government in three months on any further steps required.

To conclude, the Minister for Health, Deputy Stephen Donnelly, and the Minister for Social Protection, Deputy Heather Humphreys, have undertaken to consider the report of the Attorney General in full and to revert to the Government in three months regarding any further steps that may be required. I am happy to take any questions from members of the committee.