Áine Brady (Kildare North, Fianna Fail)

Amendment No. 31 limits the power of the National Treatment Purchase Fund to examine the records and accounts of approved nursing homes. The amendment is legally ambiguous, as the interpretation of what is reasonable could differ in the view of the National Treatment Purchase Fund and the private nursing home. It would also be administratively cumbersome and time consuming. It would require a number of written notices by the fund, the nursing home and the Minister, and the designation of a further individual to examine the accounts of the nursing home and prepare a report. The amendment would also exclude the board from receipt of the final report and is unclear with regard to who would determine the final outcome or agreed price, if any. As such, it would leave a lacuna within the legislation that would serve to undermine the entire scheme. The existing provision states the fund may examine the accounts of private nursing homes wishing to be a part of the scheme. As such, it is enabling rather than prescriptive. It ensures the fund is legislatively supported in its role to seek a fair price for nursing home care which represents value for money for the taxpayer, as well as to guard against price collusion and cartel behaviour.

Senator Mullen raised the issue of quality and standards in nursing homes. The Health Act 2007 provides for the establishment of the Health Information and Quality Authority and the registration and inspection of all nursing homes by the office of the chief inspector of social services which is part of HIQA. This will replace the current system, set out under the Health (Nursing Homes) Act 1990, where the HSE registers and inspects private nursing homes only. All private nursing homes are inspected twice a year under this system which will now include public nursing homes also. Formal standards are a key requirement for inspection and registration. The Minister for Health and Children approved the national quality standards for residential care settings for older people in Ireland in February. There are 32 standards, under seven groupings: rights, protection, health and social needs, quality of life, staffing, the care environment and governance and management. These standards acknowledge the unique and complex needs of the individual at the centre of care and are based on service providers delivering a person-centred and comprehensive service that promotes health, well-being and quality of life. The chief inspector will inspect residential centres against these standards. The inspections will commence on 1 July 2009.

Each public nursing home will have to publish the price of a bed but also how this price was decided. The public and this House will know how the price was arrived at because it will be laid before the House in accordance with section 33(2).

Senator Twomey is concerned at the transparency of the level of funding committed to the scheme each year. A dedicated subhead, B16, has been established within the HSE Vote, Vote 40, for the purpose of the scheme. This amounts to some €909 million this year, including €55 million for the fair deal scheme. The funding available for the scheme will always be ring-fenced and will be clearly identifiable within the Revised Estimates of public expenditure. Funding within the subhead will be the subject of careful monitoring and the Department of Health and Children has already agreed a set of reporting requirements in this regard.

Furthermore, under section 31 of the Health Act 2004, the HSE must prepare and submit a service plan. The Minister has stipulated that the service plan must report on the number of people provided with support under the scheme. The current plan reflects this within its performance activity targets for services for older people. The HSE will also include in its annual reports any information that may be specified by the Minister for Health and Children.

The provision enabling the National Treatment Purchase Fund to view the accounts of private nursing homes is enabling rather than mandatory. In an area of acknowledged demand for services and a sector that will have to respond to an increasing demographic trend, this enabling provision is a vital mechanism to ensure value for money for the taxpayer and to underpin the resource cap for the scheme.

The National Treatment Purchase Fund will publish a code of conduct with regard to its treatment of this material. The code will guarantee that the information is treated as highly confidential and commercially sensitive and will obviously not be disclosed to third parties. The National Treatment Purchase Fund routinely obtains accounts information from private hospitals as part of negotiations with the latter. The prices agreed with the National Treatment Purchase Fund will be subject to periodic, generally speaking annual, renegotiation. The public nursing homes will have to publish their bed prices and also a list of all the cost components, such as the goods and services, that comprise the bed price. A comparable or arguably greater level of transparency is being demanded of the public sector. I do not accept this amendment.