Oireachtas Joint and Select Committees
Thursday, 14 June 2018
Public Accounts Committee
Financial Statements 2016: National Treatment Purchase Fund
9:00 am
Seán Fleming (Laois, Fianna Fail)
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We continue our discussion of the financial statements of the National Treatment Purchase Fund. As part of this meeting, we will engage with the National Treatment Purchase Fund on its 2016 financial statements and matters related to the fair deal scheme. Earlier we heard from Nursing Homes Ireland, and the matters it raised may form part of our discussion. We are joined from the National Treatment Purchase Fund by Mr. John Horan, chairman, Mr. Liam Sloyan, chief executive, Mr. Seán Flood, finance director, and Ms Liz Lottering, audit, quality and research director. From the HSE we are joined by Mr. Michael Fitzgerald, assistant national director for older people and palliative care, and Ms Deborah Jacob from the finance division. They are all very welcome to today's meeting.
I advise witnesses that by virtue of section 17(2)(l) of the Defamation Act 2009, they are protected by absolute privilege in respect of their evidence to the committee. If they are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable. While we expect witnesses to answer clearly and with candour questions put to them by the committee, witnesses can and should expect to be treated fairly and with respect and consideration at all times, in accordance with the witness protocol.
Deputy Connolly has indicated as the lead speaker. Then we will proceed with the other slots.
I apologise in advance that I have a commitment and I must leave in a moment. Mr. Horan will make the opening statement. He might summarise it as best he can because of the late hour. Before he does so, I will ask him two questions, on which he can come back in writing to the committee. I am not going to take up the committee's time. I refer first to the waiting list initiative, which is detailed on page 16 of the NTPF's accounts. The NTPF has done a lot of work on orthopaedics, ear, nose and throat, ENT, general surgery, and the waiting list initiative. I ask the witnesses to come back and tell us how much of this was done in private hospitals. I understand that in the past some of it could be done in public hospitals. I ask the witnesses to give us the breakdown of this, the details of the waiting lists for these people and, to the extent that the witnesses can, because I know an average is only an average, the average cost of the treatments under orthopaedics, whether a hip, a knee or anything else, and the average cost for ENT and ophthalmic procedures on cataracts. We all know awfully old people who come to our clinics and who have no quality of life. I am sure the procedure only costs a grand or two. I do not know the figures. The witnesses need not provide the figures now, but I ask them to give us a full breakdown of how that money is spent. There is a crying demand from people who have been on waiting lists for a long time for some detailed information on this. The witnesses can get us the full breakdown in their own time and as soon as practical. We would appreciate that. If we have any further requests for information after we receive that reply, we can come back to the witnesses in writing at that stage.
Mr. Fitzgerald, who is the assistant national director for older people and palliative care, might send me, as Chairman, or the secretariat a detailed report on where we are in respect of Abbeyleix District Hospital. He has been in contact with the people there. A decision was announced years ago to close the hospital. This has not happened, it is still there, and I hope the facility can be kept in public use long into the future. All I am asking Mr. Fitzgerald is to send a detailed note by way of up-do-date information to me.
I am looking for Deputy Aylward, who was due to take over from me. Will Deputy MacSharry take over for just two minutes until Deputy Aylward comes back? I have to leave now.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Of course.
Seán Fleming (Laois, Fianna Fail)
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I apologise. I have a prior commitment for before 5 o'clock. Deputy Aylward will substantially chair the rest of the meeting, and I will read the transcript closely during the week. Deputy MacSharry will take the Chair for a few minutes until Deputy Aylward comes back.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I call Mr. Horan.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Okay, Mr. McCarthy.
Mr. Seamus McCarthy:
I will be very brief. The National Treatment Purchase Fund, often referred to as the NTPF, was established in April 2004. The NTPF board is an independent body operating under the aegis of the Department of Health. The board's financial statements before the committee in this session relate to the financial year 2016. The audit of the board's 2017 financial statements is scheduled to commence in July of this year.
The role and focus of the NTPF has evolved over time, reflecting changes in policy and available funding. The original remit of the NTPF required it to make arrangements for the provision of hospital treatment, either within or outside the State, for patients on long-term waiting lists and to collect and validate information about patients waiting for public hospital treatment.
In 2009, the NTPF acquired responsibility for negotiating and agreeing payment rates with private and voluntary nursing homes for the provision of residential home care for older people being supported under the fair deal scheme. Responsibility for the administration of the fair deal scheme rests with the HSE.
In 2012, the NTPF moved away substantially from the direct commissioning of patient treatment and put more focus on data and analytics, pricing, and audit and quality assurance. The board reduced its staffing levels to reflect its changing role and the reduction in annual budgets. In 2015 and 2016, the NTPF provided administrative support to the HSE by disbursing payments to private hospitals providing patient treatment for the longest-waiting public patients.
In 2016, the NTPF received funding of almost €29 million to pay for patient care and €5.1 million for its other activities. The NTPF reported an operating deficit of around €320,000 for the year.
The graph now being shown to members profiles the changes in the National Treatment Purchase Fund's spend over the years 2012 to 2016. Patient care expenditure accounted for around 89% of the NTPF's expenditure in 2016. The balance, 11%, related to administration expenses.
The primary focus of the patient care expenditure in 2016 related to the provision of treatment in orthopaedic cases, at around 43%; ear, nose and throat cases, 14%; and general surgery cases, 12%. The balance, 31%, covered a range of treatments.
I issued a clear audit opinion in respect of the NTPF's financial statements for 2016. The report draws attention, however, to the NTPF's accounting treatment of staff pension benefits. The legislation establishing the NTPF gives the Minister for Health the authority to set the accounting framework for the board. In doing so, the Minister directed that pension benefits should be accounted for as they are paid, rather than as liabilities accrue, which is what generally accepted accounting practice requires. As I have explained previously to the committee, this accounting treatment for pensions is common to a number of health bodies.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thank the Comptroller and Auditor General. Mr. Horan is next.
Mr. John Horan:
I thank the Chairman and committee members for the invitation to appear here today to review the financial statements for 2016 and to discuss the operations of the National Treatment Purchase Fund. I am pleased to have the opportunity to introduce to the committee my colleagues: Mr. Liam Sloyan, who took up the position of chief executive of the organisation on 4 May 2017, Ms Liz Lottering, who is our director of audit, quality and research, and Mr. Seán Flood, who has recently been appointed as the organisation's director of finance. As I have said, Mr. Liam Sloyan was only appointed to the position of chief executive in the course of 2017. Similarly, the director of finance has only recently taken up his position. Therefore, neither of them was in office during the accounting year 2016, but between all of us, we will be pleased to deal with any queries committee members may have about the financial statements for that year.
We have provided committee members with some background material. Rather than go through this in detail, I propose, by way of this opening statement, to deal briefly with some aspects of the matters. In the interests of good timekeeping and given the late hour, I propose not to cover all the material supplied to the committee in the written version of this opening statement, the Acting Chairman might be glad to hear.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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We appreciate that.
Mr. John Horan:
The members have it in writing and can refer to the hard copy if they wish.
I am pleased to be in a position to report that since its inception the National Treatment Purchase Fund has carried out some great work in delivering faster treatment to hundreds of thousands of patients in the public healthcare system. While not wishing to delve too much into the history of the organisation it is worth noting that in its first decade as an independent agency, the NTPF succeeded in reducing inpatient waiting times for public patients from their original levels of two to five years - depending on the category - down to an average waiting time of 2.5 months. This was achieved through the direct commissioning of patient-level treatment for public patients by the NTPF - mostly in private hospitals.
In 2012 the Government assigned additional responsibilities to the NTPF and effectively signalled the end of the organisation’s direct patient treatment commissioning role. It also reflected a major resulting change in the operational framework of the NTPF, as this commissioning work had represented a significant part of the activity of the NTPF since its inception, as we have seen in the presentation by the Comptroller and Auditor General. The result was that the organisation re-focused its efforts on areas such as data and analytics, audit and quality assurance and its role in respect of the nursing home support scheme, which was referred to earlier. Through these, the organisation continued to provide valuable support services to the broader healthcare system at a time when it was undergoing significant change and reform.
In 2014 a new NTPF board was appointed, one of the first selected under the Public Appointments Service process. This board has a wide range of skills covering areas such as medical, legal, accounting, IT, procurement, personnel and general management. While continuing to oversee the ongoing operations of the organisation, at that time this board applied itself particularly to the task of preparing the organisation through the development of a detailed strategy and action plan, all aimed at supporting performance improvement for the faster treatment of patients. The outcome of this work meant that the NTPF was well placed to support the commitments contained in A Programme for a Partnership Government of 2016 in the specific funding allocated to the organisation to reduce waiting lists in 2017 and 2018.
On foot of the decision of the then Minister for Health in 2016 to re-establish the individual patient-level commissioning role of the NTPF and, importantly, with the allocation of the enabling funding, the organisation is particularly well placed now to make an increased positive and valuable contribution again towards shorter waiting times for patients. I say this with confidence based on the organisation's proven track record of having done so in the past. It is also based on what has been achieved more recently - in the past 12 months. The outline of the organisation's objectives is contained in my written statement, which has been provided to the committee.
In order to deliver on the requirements placed on the organisation under the programme for Government 2016 the NTPF budget was increased to €20 million last year, with a further €55 million committed for the current year. I am pleased to report that we have successfully resumed commissioning of patient treatment and that detailed arrangements are in place with private hospitals for this work. An in-sourcing initiative was also undertaken to treat patients in public hospitals for specific procedures and treatments. Through this process - and using €5 million of the €15 million allocated to us for patient treatment work in 2017 - day-case patients were brought into the system and more were then placed on treatment pathways in private hospitals. A further tranche of funding was then committed to an in-sourcing initiative under which up to €5 million was provided for treating patients in public hospitals. In the second half of 2017 a third phase of spending was decided upon based on our experience with the first two private and public elements.
A specific target was that the active inpatient and day-case waiting list numbers would be less than 9,153. At the end of October the number was down to 7,282. We aimed to remove 7,000 patients from this list through acceptance of offers of treatment funded by the NTPF and a total of 8,192 people were removed from the list. It was proposed that 700 of the longest-waiting patients would be treated from the gastrointestinal scope waiting list and as a result of our initiative, 1,382 patients were removed. These are just figures but in human terms each one of these patients, and their families, have had their pain and suffering dealt with at an earlier date and have been enabled to get on with their lives.
Importantly, from the perspective of the Committee of Public Accounts, the NTPF can identify each patient and the precise treatment that he or she received. We can assure this committee that value for money was achieved and that despite the funding allocation being small in the context of the overall spend on health, a real impact was made. Our decisions on the specific uses for the current year's funding allocation of €50 million for patient treatment were informed by our experiences with last year's approach. By the end of this year, the organisation will have arranged treatment for a further 20,000 inpatient and day-case patients. NTPF-funded treatment is being provided in private hospitals or in public hospitals where there is available capacity. The focus will be on those waiting longest, for around 50 different procedures.
To date, in 2018, the NTPF has made arrangements for almost 9,000 inpatient and day-case patients and this has contributed to the number on the inpatient and day-case waiting list, reducing by a further 3,000 in the first five months of 2018, despite the challenges posed earlier in the year by Storm Emma. The number on this waiting list is currently 7,500 lower than at its peak ten months ago, a reduction of 9% on the list.
Earlier, I mentioned the nursing home support scheme - the fair deal scheme - which was established in 2009. The NTPF was given a specific key role on the pricing of long-term residential care. Given the significant sums of public moneys, of the order of €1 billion, being allocated to this scheme, this matter will be of particular interest to the members of this committee. While the NTPF’s role is very precisely defined and quite limited, through the Nursing Homes Support Scheme Act the organisation was given a vitally important task for the users of the system and for national finances. Specifically, the NTPF is mandated by statute to negotiate with nursing home proprietors for the purposes of reaching an agreement as to the maximum amount that will be charged for the provision of specified long-term residential care services. I am happy to be able to record that the NTPF has delivered consistently on this mandate over the past eight years. The organisation has done this by setting up the system of agreeing prices, which had not existed previously, by successfully negotiating and agreeing prices with approximately 430 nursing homes and by renegotiating and updating these prices on a fully negotiated basis with each nursing home over the years of the operation of the scheme. By the end of April 2018, more than 430 nursing homes had pricing contracts with the NTPF and the average price of long-term residential care paid to these nursing homes amounted to €955 per resident per week.
Another key figure is that these nursing homes are providing care to 17,500 fair deal residents. On behalf of the organisation, I assure members of this committee that the NTPF will continue its work to ensure that value is achieved for the taxpayer and that the substantial funds being made available to the fair deal scheme are maximised for the benefit of those assessed as being in need of long-term residential care.
The review of the nursing home support scheme has been discussed with the other group. Any proposals to amend a successful system benefitting the 17,500 residents and involving State expenditure of close to €900 million should be very carefully scrutinised and considered. The NTPF is currently working in the first instance with the Departments of Health and Public Expenditure and Reform in a review to ensure that viable and effective systems continue to be provided for both providers and users of long-term residential care nationwide. I assure the committee that the NTPF has undertaken this task with all the due diligence that would be expected of us. Our overriding concern throughout the process has been to provide the best possible inputs to the steering group, which includes the Departments of Health and Public Expenditure and Reform. This group will, in turn, bring its proposals to a broader working group that will include officials from the Department of the Taoiseach and the Revenue Commissioners.
When the review was initiated by the Department of Health, it was recognised by it that the NTPF would require professional and independent costing and other technical and relevant expertise to inform our review of pricing. We have been working with Deloitte on this and it has consulted a wide range of stakeholders and interested parties. Their work is close to completion and these matters will be considered by the steering group in the near future.
The remainder of my written statement contains information on the NTPF annual accounts, which are a matter of record and I am sure we can get into in more detail on those later. As the chairman of the NTPF board, I wish to reassure members that our objective is to ensure the National Treatment Purchase Fund continues to be well directed and managed in accordance with all appropriate governance requirements. We have a cohort of skilled board members, a committed executive team and employees giving us a base of significant experience and skills. Our aim is to ensure that all of the functions allocated to us by Government are carried out effectively and efficiently and that we will continue to be in a position to demonstrate that all funding voted to the organisation is being spent as intended to reduce waiting times for patients in the public healthcare system. I thank the Acting Chairman and members of the committee. The members of the executive and I will gladly take any questions members may have.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thank Mr. Horan. We are leading off with Deputy Connolly followed by Deputy MacSharry.
Catherine Connolly (Galway West, Independent)
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The last presentation we had was about dependency. Who would be in a position to answer that question about the levels of dependency?
Mr. John Horan:
I am not passing the buck but I think it would be more appropriate for our colleague from the HSE, Mr. Fitzgerald.
Catherine Connolly (Galway West, Independent)
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It was in respect of the levels of dependency. That was one of the reasons the HSE gave for the higher cost for public beds and nursing homes. One was the higher level of dependency.
Mr. Michael Fitzgerald:
It was. People who have a requirement for long-stay care are assessed through the needs assessment process. Although they would have long-stay care needs, there are different levels of dependency. Within the full gamut of people who require long-stay care, there will be very different individual needs.
Catherine Connolly (Galway West, Independent)
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Just on different levels of dependancy, what was said previously was that in private nursing homes as in public nursing homes the same level of high dependency exists. Indeed, everyone except for social cases that are assessed under fair deal, are all high dependency. Is that a correct statement?
Catherine Connolly (Galway West, Independent)
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Absolutely. Then there is a clinical assessment. Am I wrong in understanding that there are different levels of dependency within that clinical assessment?
Catherine Connolly (Galway West, Independent)
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So different homes would have a number of residents, some with higher levels of dependency than others.
Catherine Connolly (Galway West, Independent)
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Is Mr. Fitzgerald in a position to comment on private nursing homes as opposed to public ones in respect of the highest level of dependency?
Mr. Michael Fitzgerald:
The HSE would contend that people who generally will take up residential care services in the public nursing homes will have higher levels of dependency than in the private nursing homes. This was borne out and mentioned specifically in the review of fair deal back in 2015. That was the assessment at that stage. Dependency is a huge gamut, really, and it will have a variety of things with different personal needs and requirements. I think there would be different issues there for people with dementia at different levels and indeed for people with different levels of physical need. My comment from a HSE perspective is that we would still contend that in general the HSE will be able to provide the care for people at higher levels of dependency for a very simple fact that the model of staffing the HSE has is significantly higher in nursing than would be the case in the private nursing homes.
Catherine Connolly (Galway West, Independent)
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On the 80-20 balance, I have asked before who has decided it. Has it happened just by default?
Mr. Michael Fitzgerald:
I would say that it has happened by default. I feel that over the years private nursing home capacity increased significantly while public capacity significantly fell. Again with good reason because with the introduction of the residential standards in 2009 and even before then, many of the buildings and residences themselves in public nursing homes were of poor quality and had high levels of occupancy, particularly in bedrooms. We had to reduce our bed stock.
Catherine Connolly (Galway West, Independent)
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I saw the bed stock being reduced. I saw St. Francis's home. The Chairman is gone but he has fought a battle for Abbeyleix at the same time. In the week it was close, the HSE made an announcement that there were not enough public beds, which was particularly difficult to accept at the time.
What is the proper balance? What is the policy that the HSE has been given by the Government?
Mr. Michael Fitzgerald:
I am not aware of any specific mandated balance in that particular area. Our view is and any discussions I have had indicate that it relates to perhaps having no less than 20% if at all possible. From a HSE perspective, we would say that holding a percentage of that level and nature would be important because the HSE is also obliged that in the event of a nursing home failing, closing or something catastrophic happening in terms of the residents, the HSE has to step in to provide services.
Catherine Connolly (Galway West, Independent)
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That would have happened in respect of a home in Oughterard in Galway. Is Mr. Fitzgerald familiar with that?
Mr. Michael Fitzgerald:
Over many years of dealing with this, in my recollection there are perhaps 16 nursing homes that for a variety of reasons closed and where the HSE had to intervene or for whatever purposes had to undertake some services.
Catherine Connolly (Galway West, Independent)
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My final question before I go back to Mr. Horan is to ask why beds remain empty in public nursing homes if there is no distinction and if each patient is assessed under fair deal. If every resident is assessed, that is income for the home whether it is public or private, is that not right?
Catherine Connolly (Galway West, Independent)
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We have a situation in Carraroe in the heart of the Gaeltacht where I have lost track of how many beds are empty - I think it is 13 - while the hospital is at crisis point. Why would that happen?
Catherine Connolly (Galway West, Independent)
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Public or private.
Catherine Connolly (Galway West, Independent)
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Only limited by geographic accessibility.
Mr. Michael Fitzgerald:
Obviously they will choose something that is probably going to be close to their home or their family's home. Indeed we will have seen in the public homes where we have multi-occupancy bedrooms of a significance that people do not choose those homes not because there is any issue with the service they will get there but because there is a lack of privacy and dignity. Traditionally, private nursing homes will have fewer multi-occupancy and more single or double rooms.
Catherine Connolly (Galway West, Independent)
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In terms of choice of private nursing homes coming forward for assessment, is that down to the price negotiated as was said previously? Is it open to every single nursing home to come under fair deal?
Mr. Michael Fitzgerald:
If a nursing home is public, private or voluntary it has first of all to be registered with HIQA so it is providing the appropriate standard. On the voluntary and private provision they would have to negotiate through the National Treatment Purchase Fund. If a public nursing home is opening, the cost of care around the key cost elements that are laid down in the legislation will be the calculation of the cost of care it will get as an income.
Catherine Connolly (Galway West, Independent)
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I am just going to go back for my last ten or 15 minutes.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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You have 20 minutes in total.
Catherine Connolly (Galway West, Independent)
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Going back to the National Treatment Purchase Fund accounts, the rent is extraordinary. It is on page 17 of the financial statement. The rent and the increase are extraordinary. The rent for 2015 was €442,897 and it has gone up to €603,805. Can Mr. Horan explain that, please?
Catherine Connolly (Galway West, Independent)
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While he is doing so, the professional expenses have significantly jumped from €61,624 - have I got the witnesses' attention or am I losing them? We are looking at page 17.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Is Mr. Flood taking this?
Catherine Connolly (Galway West, Independent)
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On page 17 we see huge changes in office rent and professional expenses. Advertising and promotion shows a huge increase. I have mentioned the office. Professional services have gone from €61,624 up to €414,941. Advertising and promotion has gone from around €8,000 to around €78,000. Can we take those three and see what explanation we can have?
Mr. Sean Flood:
On the professional services, there was an increase of €353,000 between the two years as the Deputy correctly pointed out. That is under a number of headings. For example, in terms of software support, which comes under that heading, they built a production version of the waiting list data that they keep----
Catherine Connolly (Galway West, Independent)
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Could Mr. Flood say that again?
Catherine Connolly (Galway West, Independent)
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Could we get a list of those?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Will Mr. Flood forward the list to the committee?
Catherine Connolly (Galway West, Independent)
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Mr. Horan's opening statement is a hymn of praise to himself and the service and while I have nothing against self-praise, I take a slightly different view. The National Treatment Purchase Fund was set up as a temporary measure but has become an institution and is still in place. That is not a reflection on the witnesses. It was set up by Government to reduce waiting lists. I note Galway is distinguished by being one of the worst in the region, with massive waiting lists for inpatients and outpatients.
The opening statement mentioned procuring public beds in public hospitals under the National Treatment Purchase Fund and the mind boggles at this. Its role is now to pay for public beds in a private manner in a public hospital. The witnesses will see my cynicism here. Two operating theatres closed in Merlin Park, which was nothing to do with the National Treatment Purchase Fund, but in the course of a solution a number of beds closed in St. Finbar's ward, a brand new state-of-the-art orthopaedic ward in Galway. Are the witnesses aware that beds and wards are closed in public hospitals? Are they aware that, in a centre of excellence in a brand new ward, beds were empty, though not the whole ward?
Catherine Connolly (Galway West, Independent)
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Was the NTPF aware of it?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Was Mr. Sloyan aware of the case Deputy Connolly raises?
Catherine Connolly (Galway West, Independent)
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I will come back to Mr. Flood in a minute. In the opening statement, Mr. Horan said the the National Treatment Purchase Fund was aware of capacity issues. The National Treatment Purchase Fund is now going to open the beds in St. Finbar's ward, which should be open in the first place. Is that right?
Catherine Connolly (Galway West, Independent)
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For achieving its targets.
Mr. John Horan:
For doing the work the Government has allocated to us. The Deputy said it was a temporary measure. We did a lot of good work in the first decade but our mandate changed quite significantly in 2012 and we adjusted to the new circumstances to provide a strong measure of support to the health service, which was being reformed.
I smile to myself a little at the question on public money in public hospitals. An ideological criticism has been made of us that we are giving public money to the private sector, that is, private hospitals and private nursing homes, so we decided to test the system last year to see if we could get value for money within the public hospital system. There may be a blockage in some areas while there is capacity elsewhere and we try very hard to utilise that capacity.
Catherine Connolly (Galway West, Independent)
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The HSE west in Galway states that, because of a lack of money, it cannot open St. Finbar's ward but we only discover this when a crisis arises because we are not told otherwise. Rather than providing staff for the ward or giving reasons for closing beds, we learn that the National Treatment Purchase Fund will purchase public beds in a public hospital.
Catherine Connolly (Galway West, Independent)
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Does the National Treatment Purchase Fund not have an advisory role?
Catherine Connolly (Galway West, Independent)
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Has it advised the Government or done an audit of the empty beds and wards in public hospitals in the country? Has it advised the Government that it is ridiculous to build up a long list? The orthopaedic list is the longest list and most of the people on it will have to be sent off to private hospitals at extra cost. Has the NTPF advised the Government on what is happening?
Catherine Connolly (Galway West, Independent)
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There is a difficulty with that because I was not aware there were empty beds in St. Finbar's ward, and nor was the public, until the two operating theatres closed down in Merlin Park. We then inadvertently discovered that capacity is available in St. Finbar's ward. In the meantime, the orthopaedic waiting list is the longest of all the waiting lists.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Does Mr. Fitzgerald have anything to say on this?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thought Mr. Fitzgerald might have a comment to make.
Catherine Connolly (Galway West, Independent)
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We have set up a whole new structure that was supposed to be temporary but now seems to be long-term. The rent of for the NTPF's offices costs €603,000. Why did it jump from €442,000?
Catherine Connolly (Galway West, Independent)
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That is money that could go directly into paying nurses, doctors and physiotherapists and directly into the system but is being used to rent a building. I am not blaming the witnesses and understand that they are doing their best within the system but I have to highlight this. There were also professional expenses, data collection and new software. What about advertising and promotion?
Catherine Connolly (Galway West, Independent)
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What was the NTPF advertising?
Catherine Connolly (Galway West, Independent)
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For what purpose?
Catherine Connolly (Galway West, Independent)
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What was being communicated at a cost of €78,062?
Catherine Connolly (Galway West, Independent)
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I welcome that the audit was clear except for the pension, which is an ongoing issue with different public bodies. I also welcome that the witnesses are trying to do their job but I am looking at the cost of running this. How many private hospitals are used here, in Northern Ireland and in other countries under the the National Treatment Purchase Fund?
Catherine Connolly (Galway West, Independent)
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How many are in the Republic?
Catherine Connolly (Galway West, Independent)
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Where is the other one?
Catherine Connolly (Galway West, Independent)
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There is a system for travelling abroad for treatment that is separate from the NTPF.
Catherine Connolly (Galway West, Independent)
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Someone will borrow from a credit union or the bank, go off to Germany and pay to have a procedure done there. That is nothing to do with the National Treatment Purchase Fund.
Catherine Connolly (Galway West, Independent)
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It is another system that costs a fortune. What is the cost of that?
Catherine Connolly (Galway West, Independent)
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Maybe we can come back to this question at another time.
Catherine Connolly (Galway West, Independent)
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We know that. Not many people want to go down to the credit union and borrow money to go off to Germany where they will not have visitors or family members. It is much better to have a system where beds are opened up and tax money goes into them.
Catherine Connolly (Galway West, Independent)
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All these initiatives were temporary to help with the long lists but they did not help. How long is the lease to rent the building?
Catherine Connolly (Galway West, Independent)
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When will the five year period elapse?
Catherine Connolly (Galway West, Independent)
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Are there five-year reviews?
Catherine Connolly (Galway West, Independent)
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Does the Acting Chairman want me to stop?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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The Deputy can ask a final question.
Catherine Connolly (Galway West, Independent)
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No. I will come back in.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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The delegation seems to hesitate when answering Deputy Connolly's questions, and I do not mean hesitate in the wrong sense.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I ask the NTPF delegation to get back to us.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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That is fine.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I call Deputy MacSharry and he has 15 minutes.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I welcome the witnesses and thank them for their attendance. I apologise to them for the long wait.
I shall start where we started with the last speaker. Does the NTPF accept that the current pricing model requires an overhaul?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Yes.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is that a "yes"?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Does the NTPF delegation agree that the pricing model needs to be overhauled?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I mean from a basic layman's point of view. There is a problem when it is €950 a week versus €1,500 a week.
Mr. John Horan:
I was not going to deal with the disparity between the private nursing homes and the public nursing homes. I was not going to respond to that because that is not, again, within our remit.
I might comment on the pricing relationship that we control. That, as we have said, comes in at an average of €957 a week. That arrangement has been made with more than 430 nursing homes, voluntarily negotiated, contracted and so on.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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We heard a different story earlier on, in fairness.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Yes.
Mr. John Horan:
I heard the discussion about the number of homes and so on. It was mentioned that five nursing homes closed down but our information is that it was four. Maybe a more important figure in that regard is the number of beds. In that same period the number of beds went up by 313 from-----
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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That is a matter of fact.
Mr. John Horan:
Yes, that is a matter of fact. I am getting to a point here, if I could, Deputy. The bed numbers are growing, the number of nursing homes has bee fairly static over the past three or four years. It has hardly changed. The average contract term has gone up from 19 months, about three years ago, and it is now coming in at 30 months. Private nursing homes are voluntarily sitting down to individually negotiate deals with the NTPF for the prices that will be paid under the fair deal scheme - taxpayers' money. So, more beds are being committed and the term that the people are willing to commit to is being extended. The whole thing adds up to a very large sum for the State's Exchequer so I would be very reluctant to say: "Let's have a new system."
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Does Mr. Horan like the system the way it is?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is the review finished but not published?
Mr. John Horan:
No. The pricing part of it is close to finishing. It will then go into the Department of Health and the Department of Public Expenditure and Reform. In that context, there will be a decision made on whether to move to a new pricing system, stay with the existing one or tweak the one that is there.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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What is the criteria?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Yes.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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The NTPF is one half of the equation.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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The NTPF is one half of the equation that deals with public moneys, which is what we are interested in. Earlier, some points were made and it would be remiss of us not to put them to the NTPF.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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How does one decide? Let us say Marc MacSharry is in a nursing home in Sligo so it is what I get versus what Deputy Connolly gets in her nursing home in Galway, Dublin or wherever.
Mr. John Horan:
There are four headings to the way that it is negotiated, and not necessarily in the following order. They are the costs reasonably and prudently incurred by the nursing home and providing evidence of value for money; the price that was previously charged before the fair deal scheme ever got set up; the local market price - there was talk about the inter-county rates and so on and that may be an area that is worth looking at; and, finally, the budgetary constraints and the obligation that is on the State and on us, on the citizens' behalf, to use those resources in the most beneficial and effective manner in order to provide and improve the services our elderly residents require. They are the four elements.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Let us say somebody, as mentioned earlier, borrowed €20 million to build a place but they should not have borrowed and overextended themselves. Is that kind of stuff taken into account? Is it just the operational costs that are taken into account when Mr. Horan says the NTPF considers the cost incurred evidence?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Am I correct to say that, regardless of whether a developer owes €100 million or nothing, the bodies concerned approach that aspect in the same way?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I understand. I get the picture that it is just in terms of the cost incurred.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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How can the price charged pre-2009 be relevant?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I know.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I know. In terms of a scheme, pricing pre-2009 is ten years ago.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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All right. Can the NTPF control the market price?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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If one looks at the price one paid last year to somebody else, it was the NTPF that paid the price so it is not a fair comparison, particularly if the NTPF is the only buyer in the market.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Right.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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The analysis is done against that backdrop. What is the realistic percentage?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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No. I just picked on that element because it looks a bit dodgy to me.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is all the required expertise available to the NTPF in terms of how much things should cost? I mean the cost per hour for so many staff, how much new beds cost, how much new equipment costs, etc.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Can the NTPF access information on independent pricing and all of that?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I appreciate that my next question does not fall within the remit of the NTPF but I shall ask it anyway given that the NTPF has the expertise. How can I reconcile someone paying €950 a week versus €1,400 a week? I am just taking advantage of the fact that there are experts in the room. I must ask about this matter because that is part of my role. Therefore, I am interested in hearing an explanation from the experts present. How can someone be charged €950 a week versus €1,400 a week? The position of the HSE is that it has a lot more high-dependency demands than the private sector. Is there any reason that the price cannot be €950 on the public side as well? I am sure that there is a level of dependency in private nursing homes.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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What is it in the private sector?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I understand. I realise that everybody is different.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Everybody is different.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is a scale applied?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is there no scale?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is a metric or matrix applied?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Yes.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is that part of the review?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Good. Let us say that the HSE is correct about levels of dependency. Given their personal experience and expertise in this area, do the witnesses think that is credible? I know it is not Mr. Sloyan's role but I am interested in his view.
Mr. Liam Sloyan:
One really would have to see the individuals in the HSE homes in order to determine that. My previous experience was in health insurance and in that area it was very clear that the costs incurred can vary hugely, depending on the individual. One would need to review exactly where costs are coming from in the HSE homes.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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When will the review be published?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I know about the process. When does the review go to the Department?
Mr. John Horan:
One bit of it will be happening very soon, within the next number of weeks. That is the bit where Deloitte and Prospectus will provide the NTPF with an input to assist us in deciding what proposals we should put to the Departments of Health and Public Expenditure and Reform. We will bring proposals to the tripartite steering group involving the NTPF and the two aforementioned Departments on the pricing mechanism element. We are not looking at the total budget or anything like that. I expect that we will be bringing proposals forward in a matter of weeks.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Do the witnesses think that the Act is fit for purpose?
Mr. John Horan:
I think it has done a dramatically good job in providing assistance to the almost 18,000 people who are benefiting from it right now. The nursing homes who participate in it and the residents who have signed up for it have done so willingly. It has brought a degree of certainty to an area that was causing a lot of concern for elderly people and their families. It has given them a degree of security that they did not have previously. It has been a great success from that perspective.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is it fit for purpose now or does it need to be updated?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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A lot of people do not understand it. Indeed, I have difficulty in understanding it myself at times. I know there is the 80:20 ratio and a call on 7.5% of assets for a maximum of three years. Is that correct?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Let us say a person's house is worth €650,000 and he or she has savings of €80,000 but has a very low income after tax. The person is 75 years old and lives for three years after admission to the fair deal scheme. The person's net worth on death is €730,000. Let us say for argument's sake, that the fair deal scheme needs €230,000 to cover the cost of care. What happens to the €500,000?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Where does it go?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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That goes to the estate. Okay.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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What happens in the case of surviving relatives who have no money but have a house? Are people put out of the house so that it can be sold? What way does that work?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is that for a period of time or for their lifetime?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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A life interest?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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What about a son?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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If they were not dependants, would they be put out?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Is it possible to get money back, having sold a house?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Does Revenue collect the moneys on behalf of the HSE?
Mr. Seamus McCarthy:
Strictly speaking it is not on the HSE's behalf. Revenue collects the moneys and remits them to the Exchequer. Effectively, a loan is recorded by the HSE-----
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Are administrative charges applied?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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If I have to sell someone's house or if the State is selling it, is there a charge by Revenue?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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The punter would incur that cost. Is that correct?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Does Revenue charge?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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There is no fee associated with it.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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There is a lot of fear around the scheme because people do not really understand it. I have difficulty understanding it myself.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is there a list or details available on how many homes have been taken?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Can we get data on that? Can we find out how many homes were taken and get information on the distribution of assets, estates and so on. Can the witnesses give us details on that? I know that we cannot name individuals but-----
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Are these facts available? Can that data be sent to the committee? Have homes been sold and if so, how many?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Who can provide that information to the committee?
Mr. Seamus McCarthy:
There is some information on that in the 2017 financial statements of the HSE. Some additional information is available there. However, those statements have just been presented and are not available to the committee as yet but they will be available very shortly. In a few week's time, when the HSE is before this committee again, members will have an opportunity to discuss this issue further. The Revenue Commissioners will also be coming before the committee in two weeks time and if it is put on notice, it may be able to address this issue at that meeting.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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It would be useful to have a breakdown of how it worked out in various cases, how many homes have been involved, how many individuals have benefited from the scheme, how much it cost and so on. It would be helpful to get a note on that while not naming any individuals, their net worth or any other information like that. I am sure that such a list could be numbered or coded in some fashion. It would be good to get an overall picture.
Mr. Seamus McCarthy:
What I am trying to do with the report that we have in progress is to comprehend all of these aspects. The HSE aspect assessing entitlement to support, the pricing issues and the collection of any loans that have been extended.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I have a number of housekeeping matters with which I would like to deal now. Are all board members compliant with SIPO?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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On page 22 of the financial statement it is stated that the NTPF board had no dealings with bodies connected to any of the board members. How is that achieved?
Ms Liz Lottering:
To answer the Deputy's question on the board's compliance with SIPO, we produced annual returns for 2016/2017 in respect of all board members. On top of that, we have voluntary disclosure at every meeting from an agenda item perspective, whereby the board members are asked if there is any disclosure related to any connected items for the meeting. Board members are obliged to let us know about any connections they have with any companies with which we deal or discuss at meetings. We have put in a very strong governance environment-----
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Okay, so at every meeting, that happens ----
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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-----and it is documented in the minutes that there were no disclosures at the meeting and so forth. There are no board members who have first cousins with three nursing homes or anything like that.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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That is good.
Has there ever been a protected disclosure within the organisation?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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None has ever been made in any event.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Does the NTPF come under the remit of the SCA?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is the agency handling any actions against the NTPF?
Mr. Liam Sloyan:
No. A couple of solicitor's letters have been received in respect of some of the work arranged by the HSE for which we made the payment, which is referred to in these accounts, in particular. We explained our role to the SCA and it has accepted that we are not a party.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Is that a reference to cases where a patient or resident takes an action?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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And the NTPF was asked to comment by the SCA.
Mr. John Horan:
Yes. We were asked to comment because we made the payment on behalf of the HSE but we were not involved.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Right. The NTPF is not listed in any proceedings as codefendants or anything like that.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I asked Mr. Tadhg Daly earlier about the additional charges that apply. Perhaps the HSE officials will answer this. An issue came up on my radar in respect of continence wear and a number of cases to do with the Brothers of Charity in Roscommon. Is Mr. Fitzgerald familiar with it?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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It was pointed out earlier that under the contract, everyone gets three pads per day. I do not know how patients manage it. I certainly could not manage if I was told at six in the morning that I could only use the loo three times a day. However, charges were applied to patients for all continence wear for a period. There were protracted efforts for that money to be returned to them, some of whom had disabilities. Is Mr. Fitzgerald aware that there are a number of cases ongoing? They may not be legal cases but there are a number of cases of protracted correspondence with families of residents who are seeking to have money returned to them that was taken by the institution for continence wear.
Mr. Michael Fitzgerald:
May I ask if it was in the disability services or in older persons services? I am not aware of the centre the Deputy has named.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I am working on a number of issues relating to that centre but I imagine it is not unique. That is why I am asking Mr. Fitzgerald about it.
Mr. Michael Fitzgerald:
I am not aware of it. I understand that recently there were some issues with regard to a new incontinence contract arrangement that was rolled out by my colleagues in primary care and which had some negative effects around the countryside with regard to supply, etc. I have not heard of specific instances of charging for additional continence wear. My remit very much covers older persons services and the nursing homes support scheme itself. This service is separate from the scheme but I can come back to the Deputy in this regard having consulted my colleagues in disability services.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I am interested in this and would appreciate if Mr. Fitzgerald would do that. Given the nature of it, it would be an issue if we are or have been illegally charging.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Can Mr. Fitzgerald inquire and come back to us?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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It is important that people are paid back. We heard from Nursing Homes Ireland that the contracts that are signed at the beginning provide for three pads per day. Is that something the NTPF comes up with or is it HSE-driven?
Mr. Michael Fitzgerald:
Again, I will come back with the detail. I am not aware of three pads per day. Continence wear is provided to people with medical cards where there is a requirement for it. I presume that in any of those contractual arrangements, when we went to procurement, we had professional people around the table indicating requirements. If it is three, it is three; I will argue with Nursing Homes Ireland on that. I will come back to the committee as it is not my field.
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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It just sounds a bit mean.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Has the Deputy any more questions?
Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I probably have loads more but it is late.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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That is the reason we are pushing. I want to ask a few quick questions. I want to ask the witnesses the same question I put to Nursing Homes Ireland. The Deloitte price review is being held up and Mr. Daly referred to it as "foot dragging". Can the witnesses comment on the foot dragging? Are the private nursing home providers and voluntary associations being included in the review? Are they being asked for their opinions? Are they all being included in this Deloitte report and will there be opinions sought from them on what we call a fair deal?
Mr. John Horan:
Some people might call it foot dragging; others might call it being thorough to make sure that everything is covered. I will run through it quickly. The stakeholders that were consulted under this review include the Departments of Health and Public Expenditure and Reform; HSE services for older people; HSE disability services; HSE estates; HIQA; Age Action Ireland; the Competition and Consumer Protection Commission; the Office of the Ombudsman; Nursing Homes Ireland; a number of individual nursing homes; Bank of Ireland, AIB and Ulster Bank investors; the Ireland Strategic Investment Fund; our own solicitors, Philip Lee; and a consultant geriatrician. We are being exhaustive and thorough.
There was mention of the review that was carried out on the fair deal scheme. It states: "In considering the financing of the scheme, the review concluded that the National Treatment Purchase Fund has done an effective job in introducing and managing a pricing system for long-term residential care facilities." We have done a good job and got a system up and running. It is working well. It might be possible to improve on it and we are going through a precise and thorough process to ensure that if we change the system, we come up with something that will work and that will improve the system for everyone involved.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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How often do the reviews take place? When was the last one?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Mr. Horan said the NTPF is making the contracts longer now - 30 months. Is that a good move? If a private nursing home signs up this month, it is doing so for 30 months. If the review takes place and more money is made available, is that provided automatically under the contract?
Mr. John Horan:
It is good from a number of points of view to have a two and half year contract rather than a one and a half year contract, for example. There are variations between those durations. The longer one provides a strong degree of certainty for the nursing home operator, the resident and the Exchequer. There a fixed view as to what is going to happen in a year or two years. I am sure members talk much more than I do about multiannual budgeting. That provides a degree of stability and certainty that would not exist otherwise. It is an indicator of confidence in the scheme by the operators.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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For clarification, if someone signs up for two and a half years and there is an increase in funding, will they be excluded from accessing the additional money or is it added on to the deal they have made?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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That could be part of the deal.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I was going to ask about the monopoly end of it.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I have another question that I put to Nursing Homes Ireland. One quarter of State funding covers 20% of the care.
Under the arrangement the other two thirds goes for 80% of the care. Is there a discrepancy there? In Kilkenny there is a €700 difference between public nursing home and private nursing home costs.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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The difference is €700. That is a lot of money. If the difference was €150 or €200 I might accept it, but a difference of €700 per week is a lot of money.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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The review suggests an improvement for private nursing homes and especially voluntary homes. We have some voluntary homes in our constituency. As I said earlier, they have to fundraise simply to keep the show on the road. Is that going to be taken into consideration? I am asking about the voluntary sector in particular.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I want to mention the fair deal scheme again. Can your organisation offer a comment on the agricultural side and the farming sector? There is discrimination there. I had it from Tony O'Brien. I got a commitment that there was a discrepancy. The authorities accepted it and agreed to try to do something about it. The Minister has given a commitment but it is dragging on. As we discussed already, there is a three-year cap on a house but there is no cap on a farm. Is this going to happen? Can your organisation comment on it?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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It is with the Minister, basically. It is a Government decision. Is that it?
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I asked earlier about medical cards and the service provided. A person based in his or her private home gets a service from GPs as well as all the other services. However, let us suppose a person goes into a private nursing home. Seemingly, from the evidence given earlier, that person loses all of that. Does the deputation have any comment on that? Should it be part of the arrangement when the organisation is making a deal with a private nursing home that these services should be included in the cost?
Mr. Liam Sloyan:
We are precluded from including that in the cost by the legislation. The provision of services under the medical card system is a matter for the HSE.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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Can the organisation comment on that? It seems to me to be discriminatory. People in their own homes can get these services. However, if they go into a private nursing home and are paying €1,000 or €900 per week, they are excluded from these services. To me that does not sound fair.
Mr. Michael Fitzgerald:
Certainly, it would not be fair if it was the case that a person was in a residential care centre and, therefore, we were not providing that requirement to the person. Certainly, that is not our position. I was in the Gallery and heard that stated several times. I would be most concerned if that was happening.
I wish to point out that when a person is in residential care, whether the set-up is public, private or voluntary, the person is being provided with 24-hour care and with a level of service. These people are no longer able to stay in their own homes. Let us suppose a person receives primary care services through the medical card or whatever and is provided with therapies and so on. Those services are available at a certain level. The service is a scarce resource. The service provider will be concentrating on those people who are residing alone, perhaps. Such interventions might keep people at home for longer. The fact that a person is in long-stay care, regardless of the centre and whether it is public, private or voluntary, means that person is less of a risk because of the 24-hour care and service provision.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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It is one thing to be less of a risk but another if a person needs treatment. If a person has a problem, he or she still needs to get the treatment or care. I think those responsible should review it. I am asking whether your organisation can review it.
Mr. Michael Fitzgerald:
I completely agree with you. There should be no discrimination for a person because that person is in residential care, especially if the person has a need for a service. The fact that a person is in residential care should not mean he or she should not get the services. That is what I am saying. I agree with that. I am simply saying that if an occupational therapist has a long waiting list, in fairness, the people he or she is more likely to look after are those who are at home. It would be a natural thing for the service provider to do that. That would be a clinical call. Let us suppose a person is in a residential care setting and needs a service. Is there sufficient capacity to provide that service for everyone? That is another question. There may not be.
Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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We have had a long discussion. My apologies for being so late. We do not normally go this late but it dragged on all day.
I thank all the witnesses from the National Treatment Purchase Fund and the HSE for attending and for the material they supplied to the committee. I thank the Comptroller and Auditor General and his staff as well.
The next meeting will involve representatives from the Department of Foreign Affairs and Trade. We will discuss the financial statements of the Department and chapter 14 of the Comptroller and Auditor General's 2016 report on control of Ireland's bilateral assistance programme.