Paul Coghlan (Fine Gael)
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As Senator Rose Conway-Walsh is not in the House, we will begin with Senator Colm Burke. I welcome the Minister of State at the Department of Health, Deputy Finian McGrath to the House.

Colm Burke (Fine Gael)
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I welcome the Minister of State to the House and thank him for dealing with this Commencement matter, which relates to the private nursing home sector. At present, there are over 23,500 people in private nursing home beds under the fair deal scheme. An issue has been raised with me by representatives of a number of private nursing homes regarding the fact that when the price is fixed - and it is fixed at different levels in different areas - there is no right of appeal for them. There is no process by which they can have the price that is fixed reviewed. They have concerns about this because private nursing homes would all have similar costs, including wages, insurance, heating and food but there is a variation in different parts of the country in the price that is set by the NTPF. The nursing homes do not have any mechanism available to them to have the price reviewed. It is in that context that I raise this matter and ask that an appeals process be put in place. I am not saying that everyone would be entitled to appeal but where there are reasonable grounds for an appeal, namely, that the price set does not take into account all of the issues faced by the nursing home on a day-to-day basis, an appeal should be possible.

Finian McGrath (Dublin Bay North, Independent)
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At the outset, I thank Senator Colm Burke for raising this very important matter.

The legislation underpinning the nursing home support scheme requires each private nursing home negotiate and agree a price for long-term residential care services with the National Treatment Purchase Fund, NTPF, should it wish to be an approved nursing home for the purposes of this particular 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 the State. In negotiation with the nursing homes, the NTPF has regard to cost reasonably and prudently incurred by the nursing home and evidence of value for money.The NTPF also has regard to price, prices or prices previously charged, local market price, budgetary constraints and the obligation of 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 homes support scheme commenced in 2009, a commitment was made that it would be reviewed after three years. In advance of the review, which was the subject of an extensive and structured public consultation process, submissions were sought from groups or bodies wishing to make a contribution. Nursing Homes Ireland made a submission in this regard and sought an appeals system for nursing home providers.

The report of the review was published in July 2015. A number of issues were identified for more detailed consideration, first, a review of the pricing mechanism of the National Treatment Purchase Fund with a view to ensuring value for money and economy, the lowest possible administrative costs for clients and a minimal administrative burden for providers; second, the need to increase the transparency of the pricing mechanism in order that existing or potential investors can make informed decisions to the greatest extent possible; and, third, to ensure adequate residential capacity for those residents with more complex needs.

Deloitte and Prospectus have been engaged by the National Treatment Purchase Fund to assist in carrying out the review. They have engaged in extensive stakeholder consultation and this includes Nursing Homes Ireland. The pricing review will include consideration of the appeals mechanism. It is not deemed feasible to effectively address this issue 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. In this context, we need to be careful about placing too much reliance on an appeals system. There is little point in establishing an appeals system which quickly becomes the default option for almost all of the operators and, therefore, effectively displaces the main price-setting mechanism. It is more important to develop a robust system that everyone understands and that delivers fair outcomes consistently. If we can achieve this, an appeals system per sewill become far less important.

Colm Burke (Fine Gael)
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I thank the Minister of State for his comprehensive reply. I agree fully with the Minister of State in respect of his last point. Such an outcome is the last thing we need. It reminds me of every District Court case that is sent to the Circuit Court, and that is not what I want. It may be that only one price agreement in every 1,000 is fixed but some mechanism is needed. The Minister of State referred to arranging this. Do we have a timescale for when the changes under discussion will be put in place? Will some mechanism be in place to deal with concerns or cases where someone believes that not all issues have been dealt with in coming to a conclusion about a price fixed for a nursing home bed?

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Colin Burke for raising this important issue. Since we have over 23,000 people in nursing homes in the State, we have to be vigilant and ensure they have the proper services and prices.

Senator Burke raised the issue of no right of appeal. I will bring his concerns back to the Minister for Health, Deputy Harris. Of course I take his point about reasonable grounds for an appeal. That is important. I also think we should not necessarily blow the idea of a mechanism out of the water.

The final issue raised by Senator Burke was on the timescale. I cannot answer the question directly today, but I will bring it back to the Minister for Health, Deputy Simon Harris, and ask him for an update. I will respond to Senator Burke in the coming days.