Brendan Howlin (Wexford, Labour)
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601. To ask the Minister for Health if he will set out the level of consultation with private nursing homes to determine the ratio, in relation to statements made by his Department concerning dependency levels within private nursing homes; if he will set out the average cost per resident in HSE-operated nursing homes for 2022; and if he will make a statement on the matter. [3993/23]

Mary Butler (Waterford, Fianna Fail)
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In December 2021, the Department of Health published the independently chaired Value for Money (VFM) review on nursing home costs. The VFM Review sought to identify, quantify and analyse the in 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. 

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 review 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. 

Regarding the compilation of the VFM review it should be understood that, as outlined by the review, the study ‘would not be statistically representative, the Steering Committee were of the view that it would provide useful insight on a micro level into the care needs of residents in nursing homes, and whether any preliminary findings would highlight differences in care needs that would explain cost differentials.’ The VFM review goes further and states that it ‘must also be reiterated that this data cannot be interpreted as being a representative sample of either a public or private provision, as the sample included in this study is extremely small (<1%) and is not statistically relevant.’ Therefore, whilst the information gleaned by the VFM review provides a valuable snapshot of dependency levels across public, private and voluntary nursing homes, a clear picture of the actual differing dependency levels remains uncertain. 

I recognise that, in many cases, private and voluntary nursing homes also deliver very complex levels of care to residents.

However, it should also be noted that the HSE has a statutory responsibility to act as operator of last resort. The HSE will always step in where a resident’s needs are sufficiently complex that they are not able to be cared for elsewhere in the community and needs to be staffed to deliver that kind of complex care. This function of the HSE extends beyond long-term residential care provision.

The VFM Review made nine recommendations which the Department continues to take forward. As per Recommendation 7, the HSE has committed to publishing detailed additional information in respect of costs from 2022 onwards. According to data published by the HSE, in 2022 there was a minor increase in the average cost of care from €1,674 per week in 2021 to €1,698 per bed per week in 2022.

This 1.4% increase was influenced by pay increases provided under the Lansdowne Road Agreement (funded separately to NHSS funds allocated within the HSE Service Plan 2022).  Further information can be found on the HSE website by following this link: www.hse.ie/eng/services/news/media/pressrel/annual-updated-cost-of-providing-care-in-public-residential-care-centres-for-older-people-published.html 

It should be noted that under the Fair Deal scheme, regardless of whether a person resides in a public or a private/voluntary nursing home, the contribution to the cost of their own care will be the same.

Regarding any existing disparity in dependency levels, it is anticipated that the rollout of the InterRAI Single Assessment Tool in the community, as per Recommendation 3 of the VFM Review, will provide data sufficient to draw more accurate conclusions. This rollout has already commenced and is fully operational across four sites. In addition, funding has been approved for 128 InterRAI care needs facilitators and the Department intends that InterRAI will be rolled out to long-term residential care.

Brendan Howlin (Wexford, Labour)
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602. To ask the Minister for Health if his attention has been drawn to concerns raised by private nursing home operators at the recruitment by the HSE of trained staff from their sector who have been recruited by private nursing homes from abroad and have had their visas and travel arrangements processed at a considerable cost to the private nursing homes concerned; the steps he has taken to ensure that attractive terms and conditions are available for nurses and care workers in both the private and public sectors; and if he will make a statement on the matter. [3994/23]

Stephen Donnelly (Wicklow, Fianna Fail)
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Private Nursing Homes are privately owned and run. Their terms and conditions of employment, once in line with employment legislation, are strictly between the employer and the employee.

The terms and conditions available for nurses and care workers in the public sector are set by their individual employers and are currently covered by national wage agreement, Building Momentum.