Jack Chambers (Dublin West, Fianna Fail)
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363. To ask the Minister for Health his views on whether the cost of care figures published by the HSE on 5 October 2016, for care in its nursing homes, reflects the true costs incurred for providing nursing home care; the additional elements of the cost of the State running nursing homes that are not included; if he will provide the figures for these other elements; and if he will make a statement on the matter. [32976/16]

Jack Chambers (Dublin West, Fianna Fail)
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364. To ask the Minister for Health his views on whether it is discriminatory practice to pay a national average of 53% to public nursing homes relative to private and voluntary nursing homes; the reason for the variances in fees payable for nursing home care across the country; and if he will make a statement on the matter. [32977/16]

Helen McEntee (Meath East, Fine Gael)
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I propose to take Questions Nos. 363 and 364 together.

The Nursing Homes Support Scheme (NHSS) is a system of financial support for those assessed as needing long-term nursing home care. Participants contribute according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate setting. A financial assessment is carried out by the HSE to determine how much a participant in the Scheme will contribute to the cost of their care. It is important to note that, regardless of the weekly cost of operating a public nursing home, a resident will only be asked to contribute what has been ascertained by the financial assessment as their weekly contribution under the Scheme.

The legislation underpinning the Scheme 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. The NTPF has statutory independence in the performance of its function, and negotiates with each nursing home on an individual basis. The Department of Health has no role in such negotiations. The NTPF may examine 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 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 NHSS covers the cost of the standard components of long-term residential care which are:

- Nursing and personal care appropriate to the level of care needs of the person;

- Bed and board;

- Basic aids and appliances necessary to assist a person with the activities of daily living; and

- Laundry service.

Although the NHSS covers core living expenses, residents can still incur some costs in a private or voluntary nursing home, e.g. social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme. However, it should be noted that there are no additional charges for residents in public facilities once their NHSS contribution has been assessed.

When the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. A number of issues have been identified for more detailed consideration, including a review of pricing mechanisms 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;

- Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible; and

- Ensuring that there is adequate residential capacity for those residents with more complex needs.

A Steering Committee has been established to oversee the review of the pricing system for private long-term residential care facilities. This Steering Committee is chaired by the NTPF and includes representatives from the Department of Health, the Department of Public Expenditure and Reform, and the NTPF, and has commenced its work in this area.

The HSE has recently published the cost of care for all public nursing homes. There are a number of reasons why the costs of public facilities are generally higher than those in the private sector, including a higher nurse staffing ratio and the impact of public service rates of pay and conditions of employment.

The geographical spread of residential placements is also a factor. In some rural areas long stay beds are provided for geographical reasons in smaller centres which would not be profitable for a private provider to supply, e.g. Achill Island; Donegal.

It is important that public facilities operate as efficiently and economically as possible, and towards that end the HSE is already engaged in a comprehensive exercise to review and streamline the operation and cost structures of public facilities. Differences in the comparative cost of public and private long-term residential care will be the subject of a Value for Money and Policy Review to be undertaken by the Department of Health in 2017 to assess reasons for and components of current cost differentials.