Patricia Ryan (Kildare South, Sinn Fein)
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248. To ask the Minister for Health with regard to the recent withdrawal of a nursing home (details supplied) in Cork from the fair deal scheme due to the difference between the amounts paid per resident in private nursing homes compared with HSE public ones, if he can clarify the parameters around which the amounts are based for each payment; the measures the Government will consider putting in place to prevent further exodus of private nursing homes from the scheme; and if he will make a statement on the matter. [25332/23]

Mary Butler (Waterford, Fianna Fail)
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Fair Deal was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families. Government funding for Fair Deal is to support vulnerable older people at a time in their lives where full time care is essential.

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.

The Government is conscious of the financial challenges faced by the nursing home sector, particularly inflationary cost increases. The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic. Over €149m of financial support has been provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS) and the provision of free PPE and oxygen to private nursing homes continues, costing approximately €75 million to date.

A new €10 million scheme (TIPS) was established last year to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home, over the period of July-December 2022 (up to a maximum of €31,500 per nursing home). This scheme was extended to March 2023 and is now under review for extension for a second time up until the end of June 2023.

In addition, other options to support nursing homes are also being explored, such as to help with the often costly nature of compliance for nursing homes under necessary HIQA regulations.

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 Community Nursing Units (or CNUs) generally having a higher cost of care. It is important to note that the HSE is statutory 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. The HSE needs to be equipped to deliver that kind of complex care.

The Nursing Homes Support Scheme Act 2009 sets out the basis for determining the cost of care in public centres under section 33 of the Act, which is manged by the HSE, and maximum prices in private centres under section 40 and section 41.

Maximum prices in private nursing homesThe 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; andd) 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.

Overall, 425 private nursing homes negotiate with the National Treatment Purchase Fund (NTPF). The Department of Health and I have regular interaction with the NTPF and met them last week to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed. Nursing homes which had a scheduled renegotiation of their Deed of Agreement this year with the NTPF have seen a significant uplift.