Mr. Peter Tyndall:

I will start with the financing issue. HIQA has made it very clear that nursing homes are expected to ensure that residents have access to adequate social programmes. I have no problem with that and it is entirely appropriate. It is clearly not covered within the contract of care and the cost of providing that programme is substantial. We have looked in detail at the finances of homes and on some occasions we have turned back particular decisions because of huge rises in charges without an adequate explanation, or where there has been no capacity to explain what the charge is covering and adequately separate this from the cost of care provided under the fair deal scheme. Ultimately, we must ask how much should be included in the funding of the fair deal scheme and what the contract should cover. If the gap between the contract and the income is generally of a fixed amount for people on pensions and if most of that is to be taken up by the social provision by the home itself, leaving not a huge amount of choice for the individual, it means people have either no or very little disposable income. That cannot be right. It is not for me to propose a detailed solution to that. My sense is that I would probably include more of that in the contract. It is my instinct. However, it is a matter in a sense for the political domain to find a resolution. The problem will only get worse.

We looked at it and the comment made to me was that one would need to be a forensic accountant to understand exactly what is going on in some cases. Staff time is spent on the social programme. In the context of how contracts are constructed and so on, that is currently legitimate but it leads to blurring.