Mary Butler (Waterford, Fianna Fail)
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560. To ask the Minister for Health the criteria used to determine the subvention allowed or granted under the fair deal scheme for private nursing homes; and if he will make a statement on the matter. [17943/17]

Mary Butler (Waterford, Fianna Fail)
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561. To ask the Minister for Health the criteria used to determine the subvention allowed or granted under the fair deal scheme for public nursing homes; and if he will make a statement on the matter. [17944/17]

Mary Butler (Waterford, Fianna Fail)
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562. To ask the Minister for Health the reason the subvention under the fair deal scheme for nursing homes is higher in public nursing homes than in private nursing homes; and if he will make a statement on the matter. [17945/17]

Helen McEntee (Meath East, Fine Gael)
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I propose to take Questions Nos. 560 to 562, inclusive, together.

The Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets 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 settings. 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.

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.

The legislation underpinning the Nursing Homes Support 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 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.

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 work in this area is well advanced.

In relation to the cost of care in public residential facilities, Section 33(2) of the Nursing Homes Support Scheme Act, 2009 provides for the HSE to charge for the cost of care in long-term residential care settings. The components that make up the cost of care are laid before the Houses of the Oireachtas.

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 and Donegal.

With that said, it is important that public facilities operate as efficiently and economically as possible and deliver the best possible value for money. 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 also be the subject of a Value for Money and Policy Review which will be commenced by the Department of Health in 2017 to assess reasons for and components of current cost differentials.