Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

At the heart of this matter are 73 families who are extremely worried at this point in time. They do not know what the future holds for their loved ones. They do not know how they can possibly afford to pay for their care at Beaumont Residential Care without the fair deal scheme and they do not know where else they can find a place in a nursing home. As the Minister of State is aware, as it stands, Beaumont Residential Care is due to come out of the fair deal scheme in less than ten days, on 31 May, in about a week. Since that announcement was made, the reaction from the families of residents has been one of huge concern. The residents are overwhelmingly elderly and very often vulnerable. Several of them have dementia. The possibility of having to find another care home would be enormously disruptive. There is a huge shortage of care homes in the Cork area. For many of them, it is very difficult to find places. If we put that into context, we have a situation where there is enormous overcrowding in our hospitals. People trying to get discharged from hospital have very few places to go. To lose 73 beds from the care system in Cork would be enormously challenging for the system as a whole.

The key priority here is the 73 families who are affected. They have told me that they are very frustrated at what has happened since the announcement. CareChoice operates the nursing home. Its side of events is that there has been a serious lack of engagement from the National Treatment Purchase Fund, NTPF, and the HSE. CareChoice wishes to resolve the situation but the HSE and the NTPF have not engaged with it and have not been actively seeking to find solution in this regard. Were I to design a system of care for the elderly and vulnerable, it would not be the system we have. It would not be so heavily reliant on the private sector. It is not the optimum model but it is the system we have. While it is the system we have, we need to ensure that a reasonable subvention is paid to the care homes providing this care.

I accept that the Government needs to establish value for money. I ask that the HSE and the NTPF come back to the table with CareChoice. I am not saying they have to agree with everything that is put on the table. I understand that value for money has to be achieved for the public purse but they should at least engage. At this time, the sense from residents is that they have not been offered any support by the NTPF or the HSE and they have not been offered a way of resolving things. For what it is worth, in my own attempts to raise the issue and to be fair to the HSE locally, it forwarded on correspondence that I sent to the relevant people. I contacted the NTPF and when I asked for an email address, I was told there was no email address. It has not been very easy for me, as a public representative, to make my views known to the relevant organisation. I have submitted parliamentary questions and I am raising this matter with the Minister of State. I hope that she has more success in trying to chase this up with the NTPF.

The key thing here is the families. I understand that there has been a bit of back and forth between the HSE and CareChoice and all that. However, the key thing here is that these families and the residents, most of all, are supported and kept in place and that we find a solution. Can the Minister of State offer me, the residents and their relatives any positive news or encouragement as to how we might get a resolution in the tight timeframe we have?

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy for raising this issue. The nursing homes support scheme, NHSS, commonly referred to as fair deal, is a system of financial support for people who require long-term residential care. It was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families.

Funding to support people to access services in the sector continues to be provided in line with the long-established statutory mechanisms under the Nursing Homes Support Scheme Act 2009.

This is the mechanism established by the Oireachtas at that time to provide for the processes relating to funding under the NHSS and the negotiation of prices for services for private and voluntary providers with the designated State agency, the NTPF. Accordingly, the NTPF does not discuss publicly the details of negotiations with individual nursing homes. That is the first point I have to make. Neither Ministers nor the Department of Health have a role in price negotiations with individual nursing homes, as determined by the legislation set out in 2009.

More than 425 private and voluntary nursing homes currently negotiate their deed of agreement to agree the price they can charge for a fair deal resident under the NHSS directly with the NTPF. Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria, such as costs reasonably incurred by the nursing home, local market prices, historical prices and overall budgetary capacity. Anyone who has had a scheduled renegotiation of their deed of agreement this year with the NTPF has seen a significant uplift.

To be very clear, Government funding for fair deal is to support vulnerable older people, to whom the Deputy referred, at a time in their lives when full-time care is essential. This is a very difficult decision for families and their loved ones, and it is often made at a time of crisis. That is why it is essential that I, as Minister with responsibility for older people, ensure that the budget for fair deal, which is a substantial €1.5 billion allocation this year, will last from 1 January to 31 December for all who need it. When nursing homes are intending to close or cease participating in the nursing home support scheme, residents and their families must be consulted and given appropriate notice so that new homes can be found and they can be moved in a safe, planned way.

I need to be very clear here. There is no other mechanism for funding from the public purse for nursing home residents outside the nursing home support scheme. The Deputy said there had not been much engagement with the HSE. The HSE does not have a role with regard to the funding.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Or the NTPF.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I encourage continued engagement between the nursing home providers and the NTPF to try to resolve this issue. I really mean that. Primary responsibility for the provision of safe care and services to residents in long-term residential care facilities rests with each individual care provider. The 2013 regulations set out clear obligations on a registered provider to agree in writing with a resident the terms upon which the resident resides in the designated centre, the services to be provided and the costs involved. It is imperative that nursing homes manage potential cost pressures in line with their regulatory and contractual responsibilities, maintaining the quality of care so that residents’ lived experience and comfort are not affected. Many of the families have contacted me. I know the upset this has caused for the residents, for whom it is their home from home, and the families involved. The only way forward is for consultation. If a nursing home wishes to remain as an NTPF nursing home, it must engage with the NTPF. There is no other funding mechanism available to nursing homes outside of that scheme.

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I will raise a few issues. I appreciate that people have been in contact with the Minister, and I hope she has responded and given them whatever reassurance she can. Nobody is looking for a new mechanism. I am not seeking to negotiate this with the Minister of State in the Chamber; I know that is not realistic or the way things work.

As I understand it, the way this works is that the NTPF negotiates directly with nursing homes and that the arrangements are not necessarily the same with each individual nursing home or operator but are made on a case-by-case basis. A negotiation would have occurred in this case. I also know that the uplift that has been offered to CareChoice, which has been publicly disclosed so I am not saying anything new, is approximately €16 per resident compared with approximately €183 in some other publicly run centres. While I accept that the cost basis is different, I do not expect it accounts for that level of discrepancy. I understand CareChoice is open to renegotiation and further discussion with the NTPF. It seems, however, that the NTPF is not coming back to CareChoice and is not willing to find solutions. Nobody is looking for a new mechanism. Negotiations leading to a fair outcome are being sought, which is reasonable. I appreciate that the Minister cannot get into the nitty-gritty of any contract and that there are lengthy and substantial documents involved. I ask her to indicate that when she leaves this Chamber, although it can wait until tomorrow, she will pick up the telephone to the NTPF and ask its representatives to sit down with CareChoice. Will she do that for me? Will she please contact the NTPF?

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I spoke with representatives from the NTPF last week and speak to them regularly. I cannot advocate for one particular nursing home but what I did this year was-----

Donnchadh Ó Laoghaire (Cork South Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I am not asking the Minister of State to advocate but to ask the NTPF to come back to the table.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

What I did this year was put €41 extra into the NTPF to support nursing homes. I also provided an additional €10 million on 1 July last year for the temporary inflation payment scheme, TIPS, which is still available. Each nursing home can claim up to €5,250 per month towards its inflationary costs for heating the home. Private nursing homes and voluntary nursing homes continue to receive free personal protective equipment, PPE, which started during Covid-19. This has cost the State to date between €75 million and €78 million. We continue to provide that but we have to look at this matter in the round. I have to be very clear that the NTPF is an independent statutory body. Neither I nor the Minister can get involved in any independent case-by-case funding decisions.

My understanding is that when the NTPF engages with any particular nursing home, a final price is offered and once the final price is offered, whichever home it is, and I can only speak in general, can appeal that decision. I do not agree with the figures the Deputy mentioned because they are not the figures of which I am aware. The best way forward because it is the only way to fund any nursing home that wants to be part of fair deal is through discussion. That is a very important position for older people because the more people have, the more they pay and the less they have, the less they pay, which means nursing home care is affordable to everyone. The only way to resolve this is for the nursing home provider and NTPF to talk. I know for a fact that the NTPF reached out to the home in question late last week.