Jack Chambers (Dublin West, Fianna Fail)
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533. To ask the Minister for Health his plans to act on the report, Accounts of the Public Services 2010, published in 2011 where the Comptroller and Auditor General informed him that the cost of care in Health Service Executive nursing homes was significantly higher than in private nursing homes; if his attention has been drawn to the comments in the report that residents were wrongly charged some €52 million for medicines and therapeutic services in public nursing homes; and if he will make a statement on the matter. [19398/16]

Jack Chambers (Dublin West, Fianna Fail)
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534. To ask the Minister for Health if he is aware that independent research undertaken by the Dementia Services Information and Development Centre states private nursing homes are the majority providers of specialist dementia care; if he is further aware that three quarters of persons who avail of nursing home care are of high or maximum dependency, with 80% of the care provided by the private and voluntary nursing home sector; if he accepts the Health Service Executive claims that it is providing more specialist care as the reason for its higher cost; and if he will make a statement on the matter. [19399/16]

Helen McEntee (Meath East, Fine Gael)
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I propose to take Questions Nos. 533 and 534 together.

I am aware of the research referred to by the Deputy.

Long – term nursing home care is provided through a mix of public and private provision, with the public sector providing about 20% of all beds.

There are a number of reasons why the costs of public facilities are generally higher than those in the private sector. I do accept that many residents with higher or more complex care needs are often catered for by the public system which has obvious cost implications. From an acute hospital discharge perspective the challenge to find suitable placements for those with more complex needs is often resolved in public centres where nurse staffing levels in particular can cater for their needs.

The Review of the Nursing Homes Support Scheme which was published last year reported that HSE long-term residential care facilities have the highest proportion of maximum dependent older people at just over 60% compared to that of private nursing homes with almost 35%. The most expensive of the HSE's public nursing homes generally accommodate a cohort of young chronic sick clients. These patients are complex cases with high dependency requiring significant nursing care. There are also nursing homes that specialise in the care of residents with Alzheimer’s and who need a secure environment and others who care for residents with challenging behaviours.

However, there are other reasons why costs are higher in the public system. Conditions of employment and tenure for staff are also different and the capacity of a public facility to adjust its costs in response to changed circumstances is very different. However, the NHSS Review acknowledged that even allowing for the fact that residents in public facilities may have higher care needs, costs for public facilities appear to be in excess of what applies in private facilities.

The HSE is committed to ensuring that all services, including residential services, represent good value for the taxpayer. My Department will be working closely with the HSE to examine the costs of public facilities and to address any elements that are unacceptable or inappropriate.

The National Treatment Purchase Fund (NTPF) has responsibility for setting prices in private and voluntary facilities. 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.

The Accounts of the Public Services 2010 report referred to by the Deputy notes that the HSE charged €52 million to the long-term residential care subhead in respect of medicines and therapeutic services to residents. Residents themselves were not charged for these services. In 2012 the HSE took the steps necessary to correct the position.