Rónán Mullen (Independent)

It is not that I am special but I tabled the amendment and this is a procedural matter, as I am sure Senator Twomey knows.

I am disappointed that the Minister of State has not accepted my amendments. I listened carefully to her response. This amendment does not seek to limit the ability of the board to access records. It merely seeks to postpone it by providing that in the first instance there would be the ability for the nursing homes in question to provide a rationale for their pricing. The point at issue was expressed very well by Marie Carey of Ashlawn House Nursing Home in Nenagh, who was quoted by Senator Prendergast. She referred to the common aspiration for legislation that is fair, transparent and that supports the provision of the highest standards of nursing home care. Notwithstanding what the Minister of State said about due assessment of the pricing structures of the public facilities, I am concerned that the refusal to accept my amendments will bring about a greater likelihood of disparity in the care provided in nursing homes at the time when we should look for common high standards. A nursing home may charge above the odds compared to other nursing homes but this may be because it offers extra quality facilities. By not providing for a rationale for the fee structure of nursing homes, the extra services provided, which may justify extra cost, will not be taken into account. I fear we are still fumbling in the greasy till and considering this only through the lens of cost. We are not looking through the lens of a desire to promote a culture of excellence in nursing homes.

We can consider two comparable persons of old age going into long-term nursing care and neither has property that could be availed of under the heading of ancillary State support. The income to which each has access is €800 and the State may take 80% or €640. Perhaps I am considering this too crudely but in one case a nursing home may provide a cheaper service and the State will only back that person's care to the tune of €160 a week. In the other case, where the nursing home charges €1,000 a week, the State is backing the person to the tune of €360. Four fifths of the person's income is taken but, because some nursing homes, with justification, charge more than others the State may be required to pay more in that situation and this may not be recoupable if there is no property to which the State might have access after the death of the person. I am concerned that cost is driving all of this.

It is appropriate that the Minister of State considers this amendment, which allows the window of possibility for a nursing home to give a rationale for costs and to justify them by reference to the extras being provided. This is significant because we have not got to the high quality baseline in terms of the assessment of standards in nursing homes. This is only beginning.

The Minister of State mentioned HIQA in response to a matter I referred to on Committee Stage. It is all very well to talk about the criteria by which nursing homes are judged. I raised the question of the minimum dataset that was proposed in the HIQA document. This will not apply the universally recognised high standard of data sourcing and retention, having regard to the records of each individual in nursing home care. We are a long way from having a proper, thoroughgoing assessment of what is to be provided in nursing homes, having regard to the needs of individuals in long-term residential care. For that reason the State should look closely at facilitating nursing homes in allowing them to give a rationale for the pricing structure. I do not know if it is too late to ask the Minister of State to reconsider this issue before the legislation is passed in the Dáil. What is being proposed is not the limitation of the ability of the National Treatment Purchase Fund to access records but that, prior to accessing such records, an opportunity should be given to the nursing home service provider in question to give a rationale for the pricing structure.