Mr. Paul Reid:

Like Dr. O'Reardon, I wish to pass deepest sympathies on behalf of the HSE to the families and friends who lost loved ones in nursing homes during the pandemic. I thank the committee for the invitation to attend this meeting to discuss the Comptroller and Auditor General's special report No. 110 on the nursing homes support scheme, also known as the fair deal scheme. As this is our first meeting with the incoming committee, I would like on behalf of the HSE to wish the committee well with its important work and to assure it that the HSE will assist it in every way we can. I also wish the Chairman the very best. I am joined by my HSE colleagues, Ms Anne O Connor, chief operations officer; Mr. Stephen Mulvany, chief financial officer; and Mr. Ultan Hynes, head of service, nursing homes support scheme.

As we submitted in advance of the meeting, as requested, a briefing paper on the nursing homes support scheme, I will confine my opening remarks to the following. The nursing homes support scheme is a scheme of financial support for clients who are deemed to require long-term residential care. The scheme was established under the Nursing Homes Support Schemes Act 2009 and currently supports more than 22,572 residents at HIQA-registered older persons’ residential settings. In 2020, more than €1 billion is assigned to the scheme to support those clients. The HSE provides residential care for some 20% of those funded under the scheme.

As well as being a service provider, the HSE also administers the scheme, which was the primary focus of the Comptroller and Auditor General's special report. Although the HSE administers the scheme, the National Treatment Purchase Fund agrees the weekly maximum price for private nursing homes. The cost of care for public nursing homes is calculated by the HSE and does not exceed the cost to the HSE of providing such services. The HSE acknowledges that there is a variance in the average cost of care paid to public versus private nursing homes, with HSE centres generally having a higher cost of care. There are a number of key factors driving this variance, including pay-related issues, with generally higher staff pay rates and conditions at public nursing homes, as well as higher staffing ratios. The physical build at a number of older HSE centres also adds costs due to the extra staffing levels required to manage clients in such circumstances. There was also a requirement for a reduction in the number of long-stay beds to comply with health and safety, fire regulations and HIQA compliance with residential care standards. Finally, the HSE provides residential care services in locations that are not viable for private providers. The HSE has inputted to the ongoing Department of Health value-for-money review of nursing home costs.

The administration of the nursing homes support scheme requires significant resource input by the HSE for the application process and the financial administration of the scheme, including the oversight of a process to manage payments of €1 billion annually to public and private nursing homes. I welcome the nine HSE-specific recommendations of the Comptroller and Auditor General's special report and note that the HSE has designed a management action plan which assigned responsibility for the implementation of all the HSE recommendations, the majority of which are now implemented. The HSE is committed to working proactively with all other identified stakeholders noted in the special report, including the Department of Health.