Tuesday, 19 July 2016
Nursing Homes Support Scheme
I thank the Minister of State for making time available to deal with this matter, which is in regard to nursing homes. It is a difficulty that has been experienced for quite some time which applies very much to nursing homes outside Dublin. The moneys they are entitled to collect under the National Treatment Purchase Fund, NTPF, may be far lower than the cost of providing care to elderly people. When the NTPF set out the amount to be paid, no appeals process was put in place for when there is a genuine reason for an increased amount to be paid. The figures were set in stone by the NTPF and no other opportunity is available. It is in this context I raise the matter to see whether a very simple appeals process could be put in place to deal with it. Obviously, I do not want it opening up a situation whereby everyone can appeal. Certain circumstances would have to be set out on the reasons for an appeal and why it is felt it is warranted that the figure fixed by the NTPF is unfair and unreasonable within which to provide a service.
I thank the Senator for raising this issue. The legislation underpinning the nursing home support scheme requires each private nursing home to negotiate and agree a price for long-term residential care services with the NTPF should it wish to be an approved nursing home for the proposed scheme. The NTPF has statutory independence in the performance of its functions and negotiates with each nursing home on an individual basis. The Department of Health has no role in such individual negotiations.
The NTPF examines the records and accounts of nursing homes as part of the process, with the objective of setting a fair price which delivers value for money to the individual and to the State. In negotiating with nursing homes, the NTPF has regard to costs reasonably and prudently incurred by the nursing home, evidence of value for money, prices previously charged, the local market price, budgetary constraints and the obligation on the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.
When the nursing home support scheme commenced in 2009, a commitment was made that it would be reviewed after three years. In advanced of the review, which was subject to an extensive and structured public consultation process, submissions were sought from groups or bodies which wished to make a contribution. Nursing Homes Ireland made a submission in this regard in which it sought, inter alia, as the Senator has asked about, an appeals system for nursing home providers. The report of the review, which I am sure the Senator has seen, was published in 2015 and a number of issues have been identified from more detailed consideration, including a review of pricing mechanisms by the NTPF with a view to ensuring value for money and economy with the lowest possible administrative costs and burdens for clients and the State; increasing the transparency of the pricing mechanisms so that existing and potential investors can make as informed a decision as possible; and ensuring adequate residential capacity for those residents with a more complex need.It is also doing this with a view to increasing the transparency of the pricing mechanisms so that existing and potential investors can make as informed a decision as possible and to ensure that there is adequate residential capacity for those residents with more complex needs. This pricing review will also include consideration of the appeals mechanism. It is not deemed feasible to address the situation in isolation and it must be considered as part of the totality of the pricing system review, which will be completed as soon as possible. The National Treatment Purchase Fund, NTPF, has alluded to a timeframe of the end of the year and I will hold it to that.
In this context, we must be careful about placing too much reliance on an appeals mechanism. The Senator has pointed out that this might not be open to everyone but, in establishing an appeals system, it could become a default option for operators, which could displace the main pricing mechanism. It is important to develop a robust system that everyone understands and delivers fairer outcomes consistently. If we can achieve this, an appeals system would be much less important. If we can get the pricing mechanism right and address some of the issues the Senator and others have raised with me, there would be no need for an appeals mechanism. If new mechanisms are put in place after the review is finalised at the end of the year and we are still seeing the same problems, we can address that issue afterwards. If we allow the review to be finalised, we will see what comes of it. If the Senator wishes to revert to me subsequently, we can deal with the matter then.