Colm Burke (Cork North Central, Fine Gael)
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701. To ask the Minister for Health what engagement has taken place with the HSE with regard to providing additional financial supports for patients requiring a higher level of care in private nursing homes, and in particular where these patients are being discharged from HSE hospitals and where there is no HSE community hospital beds available; and if he will make a statement on the matter. [23006/23]

Mary Butler (Waterford, Fianna Fail)
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I recognise that private and voluntary nursing homes deliver very complex levels of care to residents in many cases.

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.

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.

Regarding any existing disparity in dependency levels, it is anticipated that the rollout of the InterRAI Single Assessment Tool in the community 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.

Existing disparities in dependencies notwithstanding, the HSE has a statutory responsibility to act as operator of last resort and will assist residents to find alternative facilities.

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 and continues to work on bringing forward the recommendations that emerged from this review.

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 and continues to work on taking these recommendations forward.

The Government remains committed to ensuring that long-term residential care for older people continues to place residents’ care, wellbeing, standards and best interests at the centre of development.

The Department of Health continues to engage with the NTPF to examine ways in which funding can be used to provide support to nursing homes. In addition, the NTPF will shortly be seeking up-to-date financial &amp; operational information from nursing homes to inform further analysis and considerations of measures to support the sector. NTPF have engaged with NHI on the matter.

Budget 2023 also saw over €40 million in additional funding for the Nursing Home Support Scheme (NHSS) which has already provided an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.

As part of your question relates to operational matters, I have asked the HSE to respond directly to you.