James Reilly (Dublin North, Fine Gael) | Oireachtas source

I am pleased to have an opportunity to introduce the Second Stage debate on the Health (Amendment) Bill 2013. The Bill amends the Nursing Homes Support Scheme Act 2009 and the Health Act 1970. The primary purpose of the Bill is to give effect to the budget 2013 announcements relating to the nursing homes support scheme, public acute hospital inpatient charges and the charging of private inpatients in public hospitals. The Bill also amends certain charging provisions under the Health Act 1970 and enables the outsourcing of functions under the Nursing Homes Support Scheme Act 2009.

It was announced in budget 2013 that the asset contribution under the nursing homes support scheme would be increased from 5% to 7.5%. It was also announced that the entitlement for State support to be backdated to 27 October 2009 for people who were in nursing home care prior to the commencement of the scheme would be abolished. The HSE's 2013 national service plan sets a target of 22,761 people to be in receipt of financial support under the nursing homes support scheme at the end of 2013. Given the extreme pressure on HSE funding across the full range of its services, it is necessary to increase the asset contribution. However, residents' contributions will continue to be based on the means of the individuals concerned and on their ability to pay. Even after the increased asset contribution comes into effect, the HSE will continue to meet the greater part of the cost of an individual's nursing home care. Despite the increase in the asset contribution, it is important to note that the scheme contains several safeguards which ensure the person in the nursing home and their spouse or partner, if applicable, are adequately provided for. These are unaffected by the provisions of the Health (Amendment) Bill 2013.

The increase from €75 to €80 in the acute public hospital inpatient charge and the charging of private inpatients in public beds were announced as part of budget 2013. These measures will raise approximately €120 million in a full year. The Government believes that the new private inpatient charge makes sense in light of the serious situation we have had up to now. Insurers have been enjoying a significant subsidy. Private patients in public beds have paid a standard charge of just €75 per night. By contrast, private patients in private beds have paid up to €1,121 per night. In both cases, the patient sees their consultant privately and pays the consultant's private fees. When one realises the cost of providing this service to private inpatients is at least €200 million more than the amount public hospitals are currently allowed to raise, one can see the imperative to address the situation. The subsidy is equivalent to the cost of running a large hospital, or the cost of treating approximately 30,000 public patients every year. We cannot allow this situation to continue.

Everyone is entitled to use a public hospital. However, some people choose to be treated privately, in which case they have chosen to pay the consultant and the hospital. The Government believes that users of private services should pay for the costs of providing them. The charge for private care in a public hospital should cover the costs of providing the service, including non-consultant hospital doctors, nursing staff, medicines, blood, medical and surgical supplies, radiology, diagnostics, operating theatres, laboratories, administration and support staff. This approach is entirely in keeping with the move to universal health insurance, where public and private providers will compete on a level playing field, free of unfair subsidies. Indeed, we will need to remove this subsidy one way or another as we move to universal health insurance.

The Bill updates certain provisions relating to charges and contributions under the Health Act 1970 and enables outsourcing under the Nursing Homes Support Scheme Act 2009. Section 53 of the Health Act 1970, as amended in 2005 and 2009, now covers three different charges: public acute hospital daily inpatient charges, charges for long-term residential care under the nursing homes support scheme and long-stay charges for inpatient services. The language and concepts used in the provisions for long-stay charges have become quite outmoded due to the development over the years of a wide range of different models of residential care service provision that are tailored to meet needs in the disability, mental health and care of older people sectors. The Bill provides for the repeal of section 53. It provides in distinct and separate sections for charges for long-term residential care under the nursing homes support scheme, for public acute hospital daily in-patient charges and for an updated framework to replace long-stay charges, namely maintenance and accommodation contributions for residential support services.

The Bill updates and replaces arrangements under the repealed section 53 for maintenance charges required from those in receipt of long-stay inpatient services other than acute hospital care or services covered under the nursing homes support scheme. The replacement provisions will apply to the provision of residential care by or on behalf of the HSE in hospitals, convalescent homes, nursing homes or residential accommodation in the disability or mental health sectors, excluding residential settings already subject to their own charging regimes, namely acute hospital care and long-term residential care services provided under the nursing homes support scheme. A key and well-established principle is that people who are given residential care should make an affordable contribution towards the cost of their maintenance and accommodation.

As quality service provision is expensive, it is fair and equitable for all of those who receive publicly funded residential care to make appropriate payment toward the maintenance and accommodation costs associated with providing such services, if they can afford to do so. Funding derived from maintenance and accommodation contributions will continue to be directly applied by the HSE towards the provision of health services. There will be a continuing requirement to pay an appropriate and affordable contribution towards the maintenance and accommodation costs to the State of providing such services. Contributions will be in line with current long-stay charges. The actual contribution will depend, as it does now, on the individual's income level. Long-stay charges are currently just below 80% of the non-contributory State pension. The maximum contribution will remain at this level. The exemptions that apply to long-stay charges will continue to apply to residential support services maintenance and accommodation contributions. The HSE will continue to have the discretion to reduce the level of contribution required depending on individuals' financial circumstances, the extent to which they provide for their own maintenance and their assessed needs.

There is a commitment in the programme for Government that a Government-wide review will be carried out to identify and eliminate non-priority programmes and outsource non-critical functions, where appropriate. With this in mind, a provision enabling outsourcing is being inserted into the Nursing Homes Support Scheme Act 2009. However, no specific outsourcing proposals are under consideration at this time. The Bill also contains a provision which extends section 53A of the Health Act 1970 to public nursing homes. It is worth highlighting that the Government is committed to enhancing the quality of life of older people. We are acutely aware of the evolving health and care needs of Ireland's older population. When the nursing homes support scheme commenced, a commitment was made that it would be reviewed after three years. A public consultation to inform the review was carried out last year. A summary report of the submissions received was published on the Department's website in December. Work will continue on the review in the coming months with a view to its completion late this year or early in 2014.

I propose to outline briefly the main provisions of the Bill. Section 4 provides that the HSE may outsource its functions under the Nursing Homes Support Scheme Act 2009. Section 6 abolishes the entitlement for State support to be backdated to 27 October 2009 for people who were in nursing home care prior to the scheme commencing. This provision was originally inserted in anticipation of a large volume of applications in the initial months of the scheme. It ensured applicants would not be disadvantaged if any backlogs occurred at that time.

Given that the scheme has now been in operation for almost four years, it is considered appropriate to abolish this provision.

Section 7 increases the asset contribution to 7.5% for new entrants to the nursing homes support scheme after the enactment of the Bill. This will be capped at 22.5% in the case of the principal private residence. In the case of a couple, the cap on the principal residence will be 11.25% where one member of the couple enters long-term nursing home care.

Section 8 amends section 51 of the Health Act 1970 to add definitions of "acute in-patient services" and "long-term residential care services" to the existing definition of "in-patient services". Section 10 repeals section 53 of the Health Act 1970. The repealed provisions are either relocated to or replaced by parallel provisions in new sections of the Act which are inserted by sections 12 and 19 of this Bill.

Section 11 amends section 53A of the Health Act 1970. At present, section 53A enables the HSE to apply an economic cost of care charge to a person in an acute hospital if they are no longer receiving medically acute care and treatment and have been certified as requiring long-term residential care services. The charge applicable is the average cost of long-term residential care in public nursing homes.

This amendment will extend the provision to public nursing homes. Where a person enters a public nursing home for services other than long-term residential care - for example, respite or rehabilitation - and has subsequently been deemed by a registered medical practitioner to require long-term residential care services, the HSE may charge them the average cost of care in public nursing homes. This and the existing provision under section 53A are enabling provisions and will only apply where an individual refuses to co-operate with the application process for the nursing homes support scheme.

Section 12 inserts two new sections, 53B and 53C, into the Health Act 1970. Section 53B is a technical amendment arising from the repeal of section 53. Section 53C provides for the public acute hospital inpatient charge and raises it to €80 from its current level of €75. Currently, this charge applies for a maximum of ten days in a rolling year and, as there are no plans to change this maximum, the charge will be capped at €800 over this period. Section 53C also sets out the categories of persons who will be exempt from the charge, including medical card holders.

Section 13 amends section 55 of the Health Act 1970 and sets out the basis for the charging of all private inpatients in public hospitals. In future, where a person waives eligibility to services as a public patient, the HSE, or someone providing a service on its behalf, may impose the relevant charge. The charge is set out in the Fourth Schedule.

Section 14 inserts section 74A in the Health Act 1970 and provides for the collection of outstanding charges or contributions where the service has been provided on behalf of the HSE. Section 15 inserts as a Fourth Schedule to the Health Act 1970 a list of charges in respect of inpatient services provided to private patients in public hospitals. The charges depend on whether a patient is accommodated in a single or multiple occupancy room, or on a day case basis, and to which Schedule, as outlined in sections 16,17 and 18 of the Bill, the hospital concerned is assigned.

Sections 16, 17 and 18 insert, respectively, as Fifth, Sixth and Seventh Schedules to the Health Act 1970, the lists of hospitals to which the charges set out in the Fourth Schedule apply. Section 19 provides for the insertion in the Health Act 1970 of new sections relating to residential support services maintenance and accommodation contributions. These will replace the present maintenance charges required from those receiving long-stay inpatient services, other than acute hospital care and long-term residential care provided under the nursing homes support scheme.

Section 67A defines "residential support services" as services - other than outpatient, acute inpatient or long-term residential care services - provided by or on behalf of the HSE to a person residing in a hospital, convalescent home, nursing home or residential accommodation for persons with physical, sensory, mental health or intellectual disabilities, where the person's accommodation is provided by or on behalf of the HSE. Section 67B enables the HSE to make residential support services available to persons with full or limited eligibility.

Section 67C provides that HSE shall collect a contribution towards the cost of maintenance from a person who is receiving residential support services if the person has previously received specified services on at least 30 days within the 12-month period ending on the day in question. It provides that the Minister for Health, with the consent of the Minister for Public Expenditure and Reform, may make regulations specifying the amounts of the contributions required from persons or classes or persons, which may not exceed 80% of the maximum rate of the non-contributory State pension, as currently applies to long-stay charges. It also exempts certain categories of people from paying the contribution. These categories are consistent with current exemption provisions relating to long-stay charges.

Section 67D allows the HSE to waive the contribution, in whole or in part, in certain circumstances and requires the HSE to prepare guidelines, which must be approved by the Minister, with the consent of the Minister for Public Expenditure and Reform, setting out the circumstances in which the HSE may waive or partially waive a contribution. These guidelines will be published by the HSE.

Under this section, provision is made to take account of the extent to which an individual may provide for his or her own maintenance or partake in activities which are, for example, beneficial towards the individual's rehabilitation or address agreed care plan objectives. This will be of particular relevance to those residing in settings in the community where there is a strong emphasis on ensuring that each individual is supported to the greatest extent possible in living in the community and managing his or her own affairs.

I commend the Bill to the House and look forward to hearing the views of Senators.