Tuesday, 6 July 2021
Nithe i dtosach suíonna - Commencement Matters
Health Service Executive
I wish to raise the issue of what are called patient private property, PPP, accounts. These accounts are administered under section 2 of the Health (Repayment Scheme) Act 2006. Essentially, they are accounts that are administered by the HSE on behalf of vulnerable people who are in long-term residential care facilities run by the HSE or on its behalf. In the main, it applies to elderly people, people with mental health issues or intellectual disabilities and to wards of court. These accounts in the central unit of the HSE hold the property of these persons. That property can be administered and used by representatives of the HSE directly or by a third party or agent of the HSE for the benefit and care of the person involved. Guidelines are in place to ensure this is done ethically and in a transparent fashion in the best interests of the vulnerable person. I understand there are approximately 15,000 such accounts being administered by the HSE at present.If the Minister of State could confirm the overall number, that would be helpful.
There is a problem with how these accounts operate. Under section 2 of the Act, a patient's private property account is defined as meaning "so much of the money and personal property ... that is managed, on behalf of the person, by the Executive or by another person under an arrangement with the Executive". It refers to the property of a person in various categories, including "a person otherwise being cared for by, or on behalf of, the Executive due to a physical or mental disability or ill-health". In other words, the facility whereby money is held centrally by the HSE and then accessible in appropriate ways to pay for services only applies to people being cared for in the public system. It does not apply to people being cared for in private nursing homes regardless of how vulnerable they might be. For example, a person may be going into care who has, God forbid, an alcoholic son or daughter. It might not be possible for that person to manage money or a bank card and nor might it be desirable for it to be managed by a family member. That person might wish to have access to the facility of a patient's private property account provided to people in the public service.
I received representations on this matter from people who are familiar with the sector and work in the area of the rights of elderly and vulnerable people. They indicated they believe this puts patients in private homes at a disadvantage. They believe the accounts and property of such people should be capable of being administered and applied, on their behalf and for their welfare, where appropriate circumstances exist similar to those of a person being cared for in the public system, the only difference being that the latter is being cared for in the public system.
It would be helpful if the Minister of State could indicate to the House the number of these accounts currently in place under section 2 of the Act. I believe this developed in the context of the repayment of charges wrongly levied on people originally but it has evolved since then. Payments to people who were in institutional settings was the context for setting up this system but it has since evolved in the way I described. People who are familiar with the sector believe elderly and vulnerable people in private homes are at a disadvantage. It would be helpful to know how many such accounts exist, whether they are operating in a satisfactory manner and what safeguards are in place.
I thank Senator Mullen for raising this topic. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Donnelly, but I am also acutely interested in the nature of the question the Senator raised.
On foot of the challenges experienced due to the recent cyberattack, which required a temporary shut-down of the HSE IT system, the HSE is currently unable to access some of the information such as the relevant data from its patients’ private property accounts system, which my Department mighty usually obtain from the HSE for inclusion in a Commencement matter debate response to provide context. The disruption of the service is ongoing. The HSE is working hard to restore its IT capacity and resume normal services.
However, I am pleased to acknowledge the legal basis for patients' private property accounts is set out in the Health (Repayments Scheme) Act 2006. The scope of these provisions relate to the HSE’s duties and responsibilities to offer appropriate safeguards regarding the finances and private property of patients in the care of the HSE and of the service providers which act on behalf of the HSE. This system provides approximately 6,000 patients and residents with an option to avail of what is, essentially, a free banking service operated by the HSE on the basis of strong published guidelines which safeguard patients’ money and private property while in our care. The Senator asked how many accounts there are and he will note there are 6,000.
The question of whether the same or similar provisions could be put in place for patients in private healthcare facilities and, if so, how that might be resourced and the appropriate role, if any, of the public healthcare system, has not to date been reviewed in any detail. However, as the Senator may be aware, my Department is currently at a fairly advanced stage in the development of the national policy on adult safeguarding in the health sector. I have asked the relevant team of officials leading that work to consider whether there may be merit in exploring the expansion of the existing patients' public property legislation or the introduction of any new provisions to offer similar safeguards to private patients and residents who might wish to avail of such a service.
It is also important to bring to the Senator’s attention the decision support service. I secured funding in last year's budget for that service. Hopefully, the decision support service will be in operation by June of next year. Advocates or the persons concerned would have different levels of needing support to be able to make decisions and they would be supported in making those decisions. That service will be open to all, whether in a public or private capacity. Hopefully, that will also provide support to people in private facilities.
I thank the Minister of State for her reply. We have seen from attempts to deal with the Covid crisis, particularly in the context of nursing homes, that it really makes no difference whether people are being cared for in the HSE sector or in the private sector when it comes to certain responsibilities the State has to keep people safe. People who go into private nursing homes often do so under the fair deal scheme, which is a system set up to enable them to access their rights as citizens.
In matters related to healthcare and their financial welfare, there must be a view that all should be entitled to the same level of protection. I have said this matter could be remedied by a very small change to the 2006 Act. We live at a time when bank branches, building societies and post offices are continuing to close and are moving their services online, following a decade in which there has been significant consolidation in the number of credit unions. Older people cannot have the types of personal relationships with the staff of financial institutions as they had in the past and they have far fewer ways to manage their money. This facility could improve the situation by addressing the needs of vulnerable people and ensuring they to are protected to some degree at least, but hopefully to a large degree, from any kind of exploitation or financial misfortune.
I thank the Senator for raising this matter in the Seanad, for his comments and for drawing attention to the HSE’s important and valuable patients’ private property accounts service, which provides a high standard of security for the finances of those in our care who would not otherwise be able to manage that themselves.
I acknowledge the Senator's reference to the reduction in the number of post offices bank branches, with the Bank of Ireland recently closing a number of its branches. Older persons do not have that same access to those institutions or the familiarity they may have had with staff working in local branches. Regardless of whether people are in the public or private system, we need to be able to support and protect them from financial abuse.
Safeguarding the finances of the people in our care is a very important matter for the Government, my Department and the HSE. That is why this system was established under the Health (Repayments Scheme) Act 2006. As previously mentioned, the question of whether the same or similar provisions could be put in place for patients of private health facilities has not been reviewed to date. It is a welcome and timely opportunity to have that discussion now and to examine the merit attached to it.
Considerations of any such reforms would have to include an examination of resourcing implications and the appropriate role, if any, of the public healthcare system. The Senator referred to the fair deal scheme and we support patients in that respect. We already support people in accessing healthcare and we should adopt a holistic approach to supporting a person.
An opportunity to consider the potential merits of broadening the application of this important service or developing a similar service for non-public patients may arise in the context of the Department's ongoing development of a national policy of adult safeguarding in the health sector. I have therefore asked the relevant team of officials to consider whether there would be merit in exploring the extension of the existing patients' private property account legislation or the introduction of any new provisions of similar safeguards to private patients and residents who might wish to avail of such a service. It would not apply to only to persons in nursing homes but to persons accessing services under mental health services, people in group homes or persons with intellectual disabilities in houses. I welcome the Senator’s question and look forward to working with the Minister on it.