Seán Sherlock (Cork East, Labour)
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229. To ask the Minister for Health if he will address an issue with the fair deal scheme (details supplied). [23379/23]

Mary Butler (Waterford, Fianna Fail)
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The closure of nursing homes can put pressure on other local health and social care facilities. It is vital that the welfare of residents is ensured. 

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 reasons for any cost differential between private/voluntary nursing homes and public Community Nursing Units (or CNUs) 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 and CNUs, 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 CNUs 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 CNUs and private nursing homes. It should be note that the VFM review reiterated that the data compiled cannot be interpreted as being a representative sample of either a public or private provision, due to the extremely small (<1%) sample size and is therefore not statistically relevant.

The Department of Health acknowledges that there are variations in the cost of care across public HSE-run Community Nursing Units (CNUs) as well as across private nursing homes, with public CNUs generally having a higher cost of care. The HSE has a statutory responsibility as provider of last resort and 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 for older people.

Overall, €1.4 billion of the total Health Budget was allocated last year to support over 22,700 people under Fair Deal. This will increase to nearly €1.5 billion for 2023 and the budget has to support all residents under the Nursing Home Support Scheme (NHSS) for the full calendar year. In addition over €149m of financial support has been provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS). The provision of free PPE and oxygen to private nursing homes continues, costing approximately €75 million to date, and €10 million for the Temporary Inflation Payment Scheme (TIPS) to support energy cost increases.

The National Treatment Purchase Fund (NTPF) has been designated by the Minister for Health pursuant to Section 40 of the Nursing Homes Support Scheme Act 2009 as a body authorised to negotiate with proprietors of non-HSE registered nursing homes to reach agreement in relation to the maximum price(s) that can be charged for the provision of long-term residential care services to NHSS residents. Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria. 

The objective of the NTPF is to agree a price with each nursing home that offers value for money to the State having regard to the following criteria:

a) the costs reasonably and prudently incurred by the home and evidence of value for money;

b) the price(s) previously charged;

c) the local market price; and

d) budgetary constraints and the obligation of 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

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. 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 Nursing Homes Support Scheme Act 2009 also sets out the basis for determining the cost of care in public centres under Section 33 of the Act, which are determined and managed by the HSE. 

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 and operational information from nursing homes to inform further analysis and considerations of measures to support the sector.

The reform of the pricing system for private and voluntary nursing homes should not be viewed in isolation but in the context of wider sectoral reforms, many of which are being or have already been brought forward. The Government remains committed to delivering on the nine recommendations that emerged from the Value for Money Review on Nursing Home Costs, the 86 recommendations of COVID-19 Nursing Homes Expert Panel, especially those recommendations related to long-term sectoral reform, the five recommendations of the NTPF Review of Pricing System for Long Term Residential Care Facilities and the 16 recommendations of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants. Work continues within the Department of Health to deliver on all of these recommendations, as well as analysing the outcomes of the Skills Mix and Safe Staffing pilots which will serve to inform future policymaking.

As I understand, engagement continues between the private provider referenced in the details supplied and the NTPF.