Carol Nolan (Laois-Offaly, Independent)
Link to this: Individually | In context | Oireachtas source

1421. To ask the Minister for Health if he will provide an update on the work his Department has engaged in to implement the nine recommendations of the Value for Money Review on Nursing Home costs; and if he will make a statement on the matter. [13397/23]

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The Department of Health acknowledges that there are variations in the cost of care across public centres as well as across private nursing homes, with public nursing homes generally having a higher cost of care.

In December 2021, the Department published the independently-chaired Value for Money review on nursing home costs. 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.

The VFM Review made nine recommendations which the Department continues to take forward. It should be noted that many of the recommendations from the report were already in progress and overlap with existing workstreams.

- Recommendation 1: The establishment of an inter-agency project team to drive the delivery of the recommendations has been partially accepted by the Department. There is a significant degree of overlap with other existing workstreams, many of which were already in progress, especially in regard to implementation of the NTPF Review of the Pricing system for Long-Term Residential Care, and it was essential to avoid duplication of governance and oversight structures. Some workstreams emerging from the review recommendations are being directed from within the appropriate section/units within the Department

- Recommendation 2: the Department has engaged with the NTPF on a range of topics and data useful to inform policy making has been shared by both parties.

- Recommendation 3: The roll out of InterRAI Single Assessment Tool in the community has commenced and is fully operational across four sites. Funding was approved for 128 InterRAI facilitators in 2022 and these roles have been filled in advance of InterRAI being rolled out to long-term residential care.

- Recommendation 4: This is a complex piece of research that will continue throughout 2023. Its objective is to have successfully tested an evidence-based staffing model based on resident need in a number of pilot sites (including private, public and voluntary nursing homes), with a view to evaluating the impact on resident, staff and organisational measures. A National Taskforce, chaired by the Chief Nursing Officer oversees this work and the research is led by Professor Jonathan Drennan, University College Dublin. Work is underway within the Department on the evaluation of a reformed model of service delivery. Findings of an interim service review is currently ongoing. The respective home support and residential care policy teams within the Department are continuing to engage to ensure that developmental work in both sectors is aligned.

- Recommendation 5: Significant progress has been made since the Taskforce was established in February 2021. This is a complex piece of work that will continue throughout 2023. Its objective is to have successfully tested a staffing model based on resident need in all of the 9 sites (including private, public and voluntary nursing homes), with a view to developing national policy and roll out in 2023. In regards to nursing home pilot sites, initial assessments of resident dependency and staffing levels have now been completed, with the following stage of staffing adjustments and evaluation due to take place over the coming months.

- Recommendation 6: Terms of reference for an audit are being developed however the commissioning of this work was momentarily paused in order to allow the HSE conduct a National Bed Register of Community Nursing Units, which has subsequently been completed. It is anticipated that the audit will commence in 2023. Building on this work, a National Working Group is in place for the purpose of determining standardised definitions of bed categories i.e. Rehabilitation/Respite/Transitional Care etc. This will form the foundation of what will influence allocated resources linked to service user acuity going forward. This work is ongoing and forms part of the wider work of the National Community Based Public Residential Care Group as well as the continuous engagement with CHO areas in relation to the drivers of the cost of care specific to each unit and follow up on identified actions relating to specific units.

- Recommendation 7: The HSE has committed to publishing detailed additional information in respect of costs from 2022 onwards. The cost of care increased to from €1,674 per week in 2021 to €1,698 per bed per week in 2022. This 1.4% increase can be attributed to pay increases resulting from the Lansdowne Road Agreement. These costs do not relate to the amount a person will pay towards their care under NHSS (Fair Deal).

- Recommendation 8: This recommendation was partially accepted as workstreams were already in place to provide a suite of home support packages designed to keep minimise the need for long-term residential care for older people for as long as possible. A number of initiatives were put in place in order to support both the discharge of patients from an acute setting and demand from the community, depending on the assessed care needs of the individual client/patient. The impact of these initiatives are currently under review.

- Recommendation 9: The Government is committed to the implementation of the COVID-19 Nursing Homes Expert Panel Report and the associated timelines for implementation over the short, medium and long term. The Minister for Health established an oversight structure to ensure the implementation of the important recommendations contained in this Report. This encompassed the establishment of both an Implementation Oversight Team and a Reference Group. The recommendations in the Expert Panel report were two-fold in nature: firstly, immediate actions required for the ongoing protection and support for nursing home residents during the pandemic and, secondly, medium- and longer-term recommendations in relation to broader system reforms to enhance and better integrate nursing home care and older persons care more broadly. These recommendations are implicitly considered in the existing reform framework for the NHSS, comprising the recommendations of this review, the Pricing review, the C&AG review and the Programme for Government. Four Expert Panel Reports have been published to date.