Paul Coghlan (Fine Gael)
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I welcome the Minister of State at the Department of Health, Deputy Finian McGrath, who is here to respond to the first matter, which is from Senator Colm Burke.

Colm Burke (Fine Gael)
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I thank the Minister of State, Deputy Finian McGrath for coming to the House to deal with the issue pertaining to the nursing homes support scheme, known as the fair deal scheme. As I understand it, a review was to be carried out but the representative organisation, Nursing Homes Ireland, and all those involved in providing nurse home care under the fair deal scheme were led to believe that the review would be carried out as long ago as 2016. Nothing has occurred and a number of different dates were mentioned as to when the review be published but that has not happened.

The major challenge facing nursing homes is that their costs have risen. The cost of nursing staff and of care assistants has risen. A significant number of staff, who previously worked in the nursing home sector have been taken on by the HSE and nursing homes are finding it difficult to employ others to replace them because their charges are stuck at the same level as they were four or five years ago, whereas costs have continued to increase. A review was promised, dates were set out at an Oireachtas joint committee as to when the review would be published. This has not happened and at this stage clarification needs to be provided in order that the nursing homes can continue to provide the service to the approximately 23,500 people who are in private nursing homes under the fair deal scheme.

We have a growing elderly population and there will be more demands on the system and people are not encouraged to invest in this sector unless they know that what they will be paid for the service they provide corresponds to the rising costs of running these facilities.

I ask the Minister of State for clarification on this matter.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Colm Burke for raising and highlighting this very important issue.

The nursing homes support scheme, commonly known as the fair deal scheme, is a system of financial support for those in need of long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. Approximately 23,000 people are availing of long-term residential care through the scheme at any given time. The National Treatment Purchase Fund, NTPF, has been designated by the Minister for Health, pursuant to section 40 of the Nursing Homes Support Scheme Act 2009, as a body authorised to negotiate with proprietors of registered nursing homes to reach agreement on the maximum price that will be charged for the provision of long-term residential services to nursing home support scheme residents.As part of this function, the NTPF enters into approved nursing home agreements with registered private and voluntary nursing homes to record the maximum prices that have been negotiated. The NTPF takes the following guidelines into account in negotiating the prices: whether costs are reasonably and prudently incurred by the nursing home and evidence of value for money; 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 all of the public. The NTPF is independent in its functions in reaching maximum pricing agreements with proprietors of registered nursing homes.

The report of the nursing homes support scheme review, published in 2015, identified a number of issues for more detailed consideration, including a review of the pricing mechanism used by the NTPF with a view to ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers. A second issue identified by the report was increasing the transparency of the pricing mechanism so that existing and potential investors could make as informed decisions as possible and a third was ensuring adequate residential capacity for those residents with more complex needs.

As the Senator himself has said, a steering group was established in 2016 to oversee and manage the pricing review. The steering group was chaired by the NTPF and included representatives of the Departments of Health and Public Expenditure and Reform. As part of its work on the review, the NTPF sought various inputs, including external expertise and stakeholder engagement, to inform the review. These inputs have been considered in great detail. It is recognised that any change to any part of the scheme must be considered in terms of short-term and long-term impact on the viability of the scheme and accessibility of long-term residential care in general. I am please to advise Senator Colm Burke that the review is expected to be completed very shortly.

Colm Burke (Fine Gael)
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I thank the Minister of State. My only concern is with the definition of "shortly". This matter has been going on since 2016. There are complex issues involved. The problem we now have is that there are complex cases in the private nursing homes sector. These homes are not being funded to the same level as HSE-run facilities. To give the Minister of State an example, I know of two units of 100 beds each, both of which were built within the past ten years. One is run by the HSE and the other by the private sector. They are both HSE facilities. The unit run by the private sector is costing €900 per week per bed. The unit run by the HSE is costing €1,500 per week per bed. That is a difference of more than €600 per week. This is the problem I have with how funding is allocated. People may come in through the private sector without any major difficulties with regard to their care but as they age their care becomes more complex. The private sector, however, is not getting the same level of financial support to deal with those complex cases. That is an issue that needs to be reviewed.

The other matter that needs to be dealt with, which I know is slightly different, is the HSE not allowing dieticians to visit nursing homes. Great costs arise as a result of that. If dieticians from the HSE were visiting nursing homes monthly it would reduce the level of supplements being prescribed. These health supplements are being prescribed by dieticians employed by their manufacturers. That is another issue which needs to be looked at.

Finian McGrath (Dublin Bay North, Independent)
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Again I acknowledge the significant input and engagement from across the nursing homes sector that has informed the drafting of this report. This expertise has been considered in detail. I also ask nursing home proprietors to continue the constructive engagement they have had with the NTPF to date and I assure them that the report on the review of the system for setting nursing home prices under the nursing homes support scheme is of utmost importance to my Department.It is a mark of the success of the health system that life expectancy has increased and our population is ageing. However, we must continue to ensure that, as the health and social care needs of older people increase and they can no longer be supported to live in their own homes, they have access to nursing home places. The nursing home support scheme has supported tens of thousands of people to avail of long-term residential care since its introduction in 2009.

This review is important to the Department and it is expected to be completed shortly. Senator Colm Burke will understand how important it is that full consideration is given to the content of the review so the viability and accessibility of the scheme are assured. Of course I accept his argument regarding the two units, with one costing €1,500, the other costing €900 and the difference of €600 per week, as well as his points about the complex cases and the dieticians. I will convey those concerns to the Minister, Deputy Harris.