Seán Haughey (Dublin North Central, Fianna Fail)

I am responding on behalf of my colleague, Deputy Mary Harney, Minister for Health and Children. I thank Senator John Paul Phelan for raising this matter and am pleased to have the opportunity to set out the position regarding the health repayment scheme.

Following consideration of the implications of the Supreme Court judgment of 16 February 2005, the Government approved a statutory based repayment scheme. The Health (Repayment Scheme) Act 2006 provides a clear legal framework to repay recoverable health charges for publicly funded long-term residential care, including contracted beds in private institutions. All those fully eligible persons who were wrongly charged for publicly funded long-term residential care and are alive will have their charges repaid in full. The estates of all those fully eligible persons who were wrongly charged for publicly funded long-term residential care and died since 9 December 1998 will also have the charges repaid in full. Recoverable health charges are charges which were imposed on persons with full eligibility under the Health (Charges for In-patient Services) Regulations 1976 as amended in 1987 or charges for inpatient services only raised under the Institutional Assistance Regulations 1954 as amended in 1965. Only these charges are repayable under the scheme.

The provisions of the Supreme Court Judgment of 16 February 2005 do not apply to individuals in private nursing homes who have entered these homes under the nursing home subvention scheme. Under that scheme, the Health Service Executive is empowered to make a financial contribution to an individual towards the cost of his or her private nursing home care provided he or she qualifies on means and dependency grounds. In the case of private nursing home care the contract is between the individual and the private nursing home owner. All applications received under the scheme must be assessed within this legal framework.

The health repayment scheme was launched in August 2006 and is administered by the Health Service Executive, HSE, in conjunction with the appointed scheme administrator, KPMG-McCann Fitzgerald. The HSE has indicated that as of 20 June 2008, more than 33,400 claim forms have been received, 11,332 payments totalling more than €226 million have issued and 15,088 offers totalling more than €267 million have been made.

The applicant concerned submitted a claim under the scheme in respect of a patient who resided in New Ross Community Hospital. New Ross Community Hospital is funded under section 39 of the Health Act 2004. Section 39 allows the HSE to give assistance to any person or body that provides or proposes to provide a similar or ancillary service to the service the HSE may provide. Any organisation funded under section 39 is not, however, providing services for or on behalf of the HSE and does not have the power to levy health charges recoverable under the scheme. Any payment made by a resident of this institution is not a recoverable health charge and therefore no repayment is due under the Act.

The scheme administrator, having assessed the details of the claim, rejected the application on the grounds that the institution in which the patient resided was outside the parameters of the scheme. Section 16 of the Act provides for an independent appeals process for applicants who wish to appeal the decision of the scheme administrator. The applicant concerned lodged an appeal with the appeals office and was provided with an oral appeal hearing. The appeals officer, having considered the details of the appeal, issued a written decision to the appellant on 13 June 2008. The decision agreed with that of the scheme administrator to reject the claim on the basis that the patient resided in an institution outside the parameters of the scheme.