Dr. Colm O'Reardon:

Good morning, Chairman and members of the committee. Before I begin, I congratulate the Chairman on his appointment and wish him and the members of the committee every success in their work. The Department is obviously pleased to work with the committee. We see this engagement as important and helping us in our role.

In talking about nursing homes, it is important to record again the serious impact which Covid-19 has had on residents of nursing homes this year and to again express our condolences to the families of those who lost their lives in nursing home settings. It is equally important to commend all of those who worked tirelessly to protect nursing home residents and prevent the spread of the Covid-19 virus in those settings.

The nursing homes support scheme or fair deal scheme is a system of financial support for people who require long-term residential care. The scheme, established by the Nursing Homes Support Scheme Act 2009, has been in place for more than ten years. It aims to ensure that nursing home care, when needed, is both accessible and affordable.

Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. This helps to safeguard equity of access and the sustainability of the scheme, ensuring that resources are targeted at those most in need.

When an applicant to the scheme is approved, following both the care needs and financial assessment, he or she can choose his or her preferred nursing home regardless of whether it is public, private or voluntary once that nursing home has an available bed and can cater for the care needs. Applicants' level of contribution is unaffected by their choice of nursing home and all registered nursing homes are regulated by HIQA against the same set of standards for safety and quality.

In 2019, almost 23,000 residents were supported by fair deal. For 2020, additional investment of over €70 million to the scheme brought its annual budget to over €1 billion for the first time, to support over 24,000 residents. The Government has also made €90 million available this year through a temporary financial scheme to support private and voluntary nursing homes to prepare for and manage Covid-19 outbreaks. Funding for fair deal represents 6% of the current health vote.

The Department welcomes the Comptroller and Auditor General's report, which provides an overview of the scheme after its first ten years in operation. The report acknowledges the complexity of the scheme and recognises its cash limited nature, which can create challenges with regard to waiting times for access and timely discharge from acute care.

The Department fully supports the report and its findings and has commenced engagement with the HSE and the National Treatment Purchase Fund, NTPF, regarding the report's recommendations. This includes initial consultation with the HSE on the recommendation for the Department to review the cost components of the scheme.

The principles underlying fair deal remain essential in our planning for services that can meet the diverse needs of our older citizens.

To ensure fairness, value for money and equity of access, the Department is committed to the development of a standard assessment tool for care needs assessment, a safe staffing framework and new care models.

I thank the Comptroller and Auditor General for his comprehensive examination of the scheme, which will lead to its further development and improvement.