Stephen Donnelly (Wicklow, Independent)
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477. To ask the Minister for Health if he will provide clarification regarding any changes to the fair deal scheme in view of claims from a person (details supplied) that participants in the scheme are now being asked to cover a shortfall between nursing home costs and the amount covered by the national treatment purchase fund; the way supplementary payments from participants will be reconciled with the financial safeguards of the fair deal scheme should they come into conflict with those safeguards, for example, if supplementary payment leaves the participant with a personal allowance of less than 20% of their income; if the Health Service Executive is aware of and approves nursing homes asking for supplementary payments; and if he will make a statement on the matter. [44779/13]

Kathleen Lynch (Cork North Central, Labour)
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The legislation underpinning the Nursing Homes Support Scheme (NHSS) requires each private nursing home to negotiate and agree a price for long-term residential care services with the National Treatment Purchase Fund (NTPF) should they wish to be an approved nursing home for the purposes of the Scheme. This is a necessary feature of the scheme due to the commitment by the State to meet the full balance of the cost of care over and above a person's contribution.

The NTPF is independent in the performance of this function and, in carrying it out, it must ensure value for money for both the individual and the State. It negotiates with each nursing home individually and may examine the records and accounts of nursing homes as part of the process. This method of negotiation is necessary in order to ensure that the State obtains the best value for each individual in a nursing home and to comply with competition law.

In negotiating with nursing homes, the NTPF has regard to:

- costs reasonably and prudently incurred by the nursing home and evidence of value for money,

- price(s) previously charged,

- local market price, and

- 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.

If price negotiations break down, a three stage review process can be invoked. Details of the process are set out on the NTPF website.

The services which fall within the scope of long-term residential care services, and which are covered by the cost agreed with the NTPF, are:

- nursing and personal care appropriate to the level of care needs of the person,

- basic aids and appliances necessary to assist a person with the activities of daily living,

- bed and board, and

- laundry service.

In determining the services covered by the NHSS, it was considered very important that nursing home residents and taxpayers would be protected and would not end up paying for the same services twice. For this reason, goods and services that are already available to individuals under an existing scheme are not included in the goods and services covered by the NHSS, as this would involve effectively paying twice for the same items or service.

A person's eligibility for other schemes, such as the Medical Card Scheme or the Drugs Payment Scheme, is unaffected by the NHSS. In other words, a person can continue to receive goods and services in accordance with the terms of these other schemes regardless of whether they are in a private nursing home or elsewhere.

It should be noted that certain items of expenditure, termed allowable deductions, can be taken into account during the financial assessment of an applicant for the NHSS. These include certain medical expenses.

There have been no changes to the goods and services covered by the NHSS since it commenced.

As the Deputy is aware, the Nursing Homes Support Scheme is currently the subject of a review. This review will consider the sustainability of the Scheme as well as looking at community based services. It will also include an examination of the overall cost of long-term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/setting prices. It is envisaged that the review will be completed in early 2014.

Finally, under the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009, the registered provider must agree a contract with each resident within one month of their admission. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should not be charged fees which are not set out in the contract.

The Health Act 2007 gives statutory responsibility to the Chief Inspector of Social Services, part of the Health Information and Quality Authority, for the independent inspection and registration of public and private nursing homes. The Chief Inspector has the power to refuse to register, attach conditions to a registration or cancel the registration of a designated centre in the event of non-compliance with the Regulations or the National Quality Standards for Residential Care Settings for Older People in Ireland .