Fergus O'Dowd (Louth, Fine Gael)
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327. To ask the Minister for Health if any consideration has been given to the provision of a capitation grant or low-interest loan scheme for small- to medium-sized nursing homes to meet the cost of required upgrades/building works in order to satisfy HIQA regulations, where that nursing home can show that it does not have the capacity to meet the financial requirements on same, and where there is a clear and identified need for beds in the area in question; and if he will make a statement on the matter. [33286/23]

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.

The long-established statutory mechanism through which private and voluntary nursing homes are funded was established by the Oireachtas under the Nursing Homes Support Scheme Act 2009. This legislation outlines the process for private and voluntary providers to negotiate the prices for their services 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 continues to meet on a regular basis since publication of the review. The group made four recommendations:

•     Recommendation 1: formal assessment of using a formulaic approach in the pricing system as set out in Section 4 of the Report.•     Recommendation 2: formal assessment of amending the approach to the assessment of “Local Market Price” to reflect prices within other nursing homes within a certain distance of the nursing home rather than within the same county.•     Recommendation 3: NTPF to engage with nursing homes and their representatives in relation to enhancing the internal NTPF Review process.•     Recommendation 4: amending the process for allowing for high dependency residents when the necessary systems are in place.

The delivery of recommendations 1-3 primarily sit with the NTPF. As per the recommendations of the review, the NTPF is reporting periodically to the steering group on progress in implementing the recommendations. It is recognised, however, that recommendation 4 has dependencies going well beyond the scope of the pricing review. This recommendation is therefore being addressed within the broader context of the reform of older persons' services, with appropriate links established between the pricing review steering group (including shared membership) to ensure that appropriate links are made between this recommendation and the others.

In addition to progressing the recommendations that emerged form the Pricing Review, Important strands of reform to the nursing home sector are being, or have 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 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 policy.

Given the size, complexity and cost of the NHSS, implementation is complex and any changes in policy direction need to be carefully assessed and kept under review. The Department of Health is consistently seeking to identify improvements and introduce enhancements to the scheme, where feasible, which aims to ensure that long-term nursing home care is sustainable, accessible and affordable for everyone and that people continue to be cared for in the most appropriate settings.