Róisín Shortall (Dublin North West, Social Democrats)
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292. To ask the Minister for Health if consideration is being given to reforming the nursing homes support scheme, also known as fair deal; if so, the timeline that he is working towards; and if he will make a statement on the matter. [53989/22]

Mary Butler (Waterford, Fianna Fail)
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Policy change to the Nursing Home Support Scheme is being taken forward across a number of areas:Assessment of Means

The Government has approved a policy change to the Nursing Homes Support Scheme, also known as “Fair Deal”, to remove disincentive for participants in the Scheme to rent out their principal residence after they have entered long term residential care. The rate of assessment for rental income from all principal residences will be reduced from 80% to 40%. This will be reviewed after six months of operation, with the potential for further amendment after that point. This policy change addresses the commitments made under Housing For All Action 19.8.

The change was made through Committee-Stage amendment to the Regulation of Providers of Building Works and Building Control (Amendment) Bill 2022. The Bill was approved by the Oireachtas on 30 June and signed into law by President Higgins on 5 July. On foot of the legislation and in consultation with the Department, the HSE is currently working to make the necessary administrative, technical and operational changes to the Scheme that will enable this measure to be rolled out imminently.

Financial Supports

Budget 2023 saw an additional €180 million of funding for services for older people for winter 2022 and into 2023, building on unprecedented increases of recent years. This will bring investment in these services to over €2.4 billion in 2023, including nearly €12 million of new developments. Prior to Budget Day I stated that my priority was to secure additional funding for Budget 2023 to ensure the continuation of all services to a high standard. Long-term residential care will be supported through additional funding for the Nursing Homes Support Scheme (NHSS) to maintain services and manage inflationary increases.

The Government has provided substantial supports to the nursing home sector over the course of the pandemic. Over €144 million has been claimed by nursing homes under the Temporary Assistance Payment Scheme (TAPS) since its introduction in 2020. The Government has now agreed to extend TAPS to the end of the year by maintaining the availability of Outbreak Assistance support.

For providers of long-term residential care who participate in the Nursing Homes Support Scheme, funding supports to help meet increased operating costs due to inflation will be allocated from the €100m health sector fund announced in Budget 2023 and will be delivered through the established mechanism of the Temporary Assistance Payment Scheme. Precise details of the scheme are being finalised and will be communicated in the coming days.

Implementation of Policy Reviews

To address strategic workforce challenges in the nursing home and home care sector, a Cross-Departmental Strategic Workforce Advisory Group (SWAG) was established in March 2022 and published a report on 15 October outlining 16 key recommendations spanning the areas of recruitment and retention, pay and conditions and overall sectoral reform. I strongly endorse the Group’s recommendations to address the critical shortage of care workers in Ireland and a dedicated Implementation Group will start to progress these immediately.

Funding to support people to access services in the sector continues to be provided in line with the long-established statutory mechanisms under the Nursing Homes Support Scheme Act 2009. This is the mechanism established by the Oireachtas to provide for the processes relating to funding under the NHSS and the negotiation of prices for services for private and voluntary providers with the designated State agency, the National Treatment Purchase Fund (NTPF). Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria. These criteria include costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity.

The NTPF carry out this role independently under the NHSS Act 2009. The NTPF has statutory independence, and there is no role for Ministers or the Department of Health in these negotiations. The Department of Health published a review of the NTPF pricing system in June 2021.

The Review of the Pricing System for Long Term Residential Care Facilities was carried out under the oversight of a steering group with representation from various departments and agencies. The group made four recommendations:

- Recommendation 1: formal assessment of using a formulaic approach in the pricing system as set out in Section 4 of the Report.

- Recommendation 2: formal assessment of amending the approach to the assessment of “Local Market Price” to reflect prices within other nursing homes within a certain distance of the nursing home rather than within the same county.

- Recommendation 3: NTPF to engage with nursing homes and their representatives in relation to enhancing the internal NTPF Review process.

- Recommendation 4: amending the process for allowing for high dependency residents when the necessary systems are in place.

A steering group has been established to oversee the delivery of the recommendations; this group has met on a regular basis since publication of the review.

The delivery of recommendations 1-3 primarily sit with the NTPF. As per the recommendations of the review, the NTPF is reporting periodically to the steering group on progress in implementing the recommendations. It is recognised, however, that recommendation 4 has dependencies going well beyond the scope of the pricing review. This recommendation is therefore being addressed within the broader context of the reform of older persons' services., with appropriate links established between the pricing review steering group (including shared membership) to ensure that appropriate links are made between this recommendation and the others.

The terms of reference for the group include a final report to be submitted to ministers, reporting on delivery of recommendations 1-4 set out above and making any further recommendations as appropriate.

A Value for Money (VFM) Review on Nursing Home Care Costs has also been carried out under the direction of a Steering Committee with an independent chair. The VFM Review sought to identify, quantify and analyse the reasons for any cost differential between private/voluntary and public nursing homes and, following analysis, to make recommendations for improving the value for money obtained by the Health sector. The review was published in December 2021 and can be viewed by following this link: www.gov.ie/en/publication/3859f-a-value-for-money-review-of-nursing-home-care-costs/

Among the issues raised were the pay costs of staff in nursing homes, the dependency levels of residents, energy costs, and medical supplies charges to the NHSS. The report found that the cost differential is largely driven by variances in staff-to-resident ratios and the skill mix in public and private nursing homes. However, the review also found that establishing like-for-like comparisons was complex and not always possible, especially when considering differences in dependency levels.

The VFM Review made nine recommendations which the Department continues to take forward.