Rónán Mullen (Independent)

I move amendment No. 31:

In page 50, to delete lines 31 to 35 and substitute the following:

" "(3) Where the Board has formed the reasonable view that the price at which long term residential care services is proposed to be provided by a particular nursing home is, all things being equal, materially in excess of the price at which long term residential care services are provided by other comparable nursing homes the Board shall have the power to request, by notice in writing, that the said nursing home provide the Board with a written explanation of the calculation of the price at which long term residential care services is proposed to be provided by such nursing home. In the event that the Board is not satisfied with a written explanation received under the terms above it shall have the power to request that the Minister as soon as is practicable, by notice in writing to such nursing home, designate a person to examine the records and accounts of such nursing home and to subsequently report the findings of such examination to the Minister and to the nursing home in question. A refusal on the part of a nursing home to comply with any notice pursuant to this section shall be construed as a withdrawal on the part of such nursing home from negotiations.".".

I am very much indebted to the Acting Chairman for not also ruling this amendment out of order. Section 41(1)(b)(iii), which was recently added I believe on Committee Stage in the Seanad at the behest of the Government, states:

In performing its functions under paragraph (1)(ba) the Board may examine the records and accounts of an approved nursing home or of a nursing home the proprietor of which proposes to enter into arrangements under paragraph (1)(ba)."

I am indebted to Nursing Homes Ireland and various others involved in the provision of nursing home care who have been in contact with Senator Quinn, myself and others, including Eileen Gallagher, director of nursing at Ryevale nursing home, and Mary McCormack, director at Glenaulin nursing home, Lucan Road. The core issue is how the State deals with public nursing homes on the one hand and privately run facilities on the other. The section the Minister of State introduced on Committee Stage seems to be at variance with statements made by the Department of Health and Children in its publication, A Fair Deal: The Nursing Home Care Support Scheme 2008, which stated:

Prices around the country are already known to the HSE and the Department and can be reasonably estimated already ... we are already aware of prices around the country and will not be obliged to reach agreements with any particular nursing home if its prices are unreasonable. We will seek co-operation from the private nursing homes' organisations.

However, what was proposed by the Government and accepted on Committee Stage was that the board may examine records and accounts of approved nursing homes. It is inappropriate for the National Treatment Purchase Fund as a monopoly purchaser to request information that is not in the public domain and especially commercially sensitive information in a competitive environment.

I accept that my amendment is somewhat lengthy. I propose that instead of the access all areas regime of being able to examine records, at the very least there should be a prior stage, namely, a request that the nursing home in question would submit its rationale for its proposed pricing. For example, if the NTPF is not in a position to get agreement with the nursing home on the prices to be charged, is it appropriate that following the Government's Committee Stage amendment, it would then be a straightforward matter of checking the records? Is it not more appropriate and fairer that there should be a request for the nursing home to submit the rationale for its pricing? If there is still no agreement, perhaps one could argue that there might be a case for viewing the records of the nursing home.

A number of issues are at stake here. One is the question of whether similar treatment is on offer to private nursing homes as distinct from public nursing homes. Is it not the case that with public nursing homes, it is a take it or leave it situation vis-À-vis the State. Their prices are out there and the State takes it or leaves it. However, with the privately run nursing homes a different regime seems to be proposed. The question must arise whether that is equitable.

The next matter goes back to an issue Senators Bradford and Fitzgerald, I and others raised earlier when we spoke about the quality of regime to which a person in nursing home care should be entitled. Surely there should be a certain set of standards to which nursing homes should adhere to guarantee the rights and dignity of people in long-term residential care. Provided they reach those standards there would be legitimate scope for the people involved in the provision of private nursing home care to operate commercially and to do a deal with the State. However, surely they should be doing a deal on the same basis as publicly run facilities do. Is there a danger that publicly run facilities might not be cost effective but are paid for none the less whereas private nursing homes are being exposed to a regime of the State insisting on viewing records? The amendment proposes a prior requirement of a request for the rationale to be given by the nursing home for its pricing structure etc.