Fergus O'Dowd (Louth, Fine Gael)
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347. To ask the Minister for Health to provide on update on the Programme for Government commitment to further support the Nursing Homes Support Scheme (The Fair Deal) to provide assistance when staying at home may no longer be an option since the establishment of the current Government; and if he will make a statement on the matter. [33323/23]

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 Department of Health acknowledges that there are variations in the cost of care across public centres as well as across private nursing homes, with HSE Community Nursing Units 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.

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 Value for Money 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 reforms.

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 I am cognisant that 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, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups. The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic. Over €150m 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 over €77 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. This scheme has been extended for a second time to the end of June 2023.

The only mechanism for funding from the public purse for nursing home residents is Fair Deal and it is really important that private and voluntary providers continue to engage in the process as set out in the Nursing Home Support Scheme Act 2009.

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 these negotiations and are based on the NTPF’s cost criteria, such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity.

Under the Nursing Homes Support Scheme Act Act 2009 the NTPF has statutory independence, and there is no role for Ministers or the Department of Health in negotiations with individual nursing homes. Overall, approximately 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 recently to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.

Budget 2023 saw over €40 million in additional funding for the Nursing Home Support Scheme (NHSS) which will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated. Anyone who has had a scheduled renegotiation of their Deed of Agreement this year with the NTPF has seen a significant uplift.

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.

I am conscious of private and voluntary nursing homes that are not scheduled to renegotiate their Deed of Agreement in 2023 and other options are being considered. One of the options under consideration is for nursing home providers to agree to a shorter contract duration with the NTPF.

Important strands of reform to the nursing home sector are being, or have been, brought forward. In addition to that outlined above, the Government remains committed to delivering on:

• The 86 recommendations of COVID-19 Nursing Homes Expert Panel, especially those recommendations related to long-term sectoral reform

• The four recommendations of the NTPF Review of Pricing System for Long Term Residential Care Facilities

• 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.

Fergus O'Dowd (Louth, Fine Gael)
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348. To ask the Minister for Health to provide on update on the Programme for Government commitment to ensure that no nursing homes support scheme resident is charged for services they do not use, since the establishment of the current Government; and if he will make a statement on the matter. [33324/23]

Mary Butler (Waterford, Fianna Fail)
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The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.

The NHSS covers the cost of the standard components of long-term residential care which are:

• Nursing and personal care appropriate to the level of care needs of the person;
• Bed and board;
• Basic aids and appliances necessary to assist a person with the activities of daily living; and
• Laundry service.

Fergus O'Dowd (Louth, Fine Gael)
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349. To ask the Minister for Health to provide on update on the Programme for Government commitment to ensure that the best possible safeguards are in place to protect our friends and family in nursing homes since the establishment of the current Government; and if he will make a statement on the matter. [33325/23]

Mary Butler (Waterford, Fianna Fail)
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Safeguarding adults who may be at risk of abuse, harm, and neglect by others in the context of their interactions with the health and social care sector, including in nursing homes, is a key objective of the Department of Health, every statutory body under its aegis and every relevant service that interacts with such adults.

In the health and social care sector, a framework of standards, policies and procedures for safeguarding adults who may be at risk of abuse, harm, neglect, and exploitation within the sector, including in nursing homes, is in place, and further measures are being developed to strengthen this framework.

Cross-sectoral legislative provisions relevant to adult safeguarding are also applied throughout the health and social care sector, including, for example, legislation on vetting and on the mandatory reporting to An Garda Síochána of information about the commission or suspected commission of certain offences against vulnerable adults or against children.

Existing governance measures

Key governance provisions currently in place include:

• The significant inspection and other regulatory powers of the Health Information and Quality Authority (HIQA) and the Mental Health Commission (MHC) in relation to the quality and safety of healthcare and social care provision generally (under the Health Act 2007 and the Mental Health Acts).
• The roles of health and social care professional regulatory bodies (including CORU, the Irish Medical Council, the Nursing and Midwifery Board of Ireland, the Dental Council of Ireland and the Pharmaceutical Society of Ireland) in relation to, inter alia, professional registration requirements and professional codes of conduct.
• Joint National Standards for Adult Safeguarding developed by HIQA and the MHC and approved by the Minister for Health, that apply to all regulated health and social care centres, including nursing homes.

• A HSE National Safeguarding Office leading policy development and oversight.
• Clear guidelines set out in the existing policy for HSE and HSE-funded staff to follow in cases of suspected abuse or neglect of adults at risk (including a “zero tolerance” approach to abuse, meaning that abuse must be reported by staff in all instances).
• An adult safeguarding policy and procedures training programme, and a requirement that staff must attend training (the training is also accessible to non-HSE and HSE-funded services).
• Social work teams ("Safeguarding and Protection Teams") in each of the 9 HSE Community Healthcare Organisation areas.
• Over 2,000 designated safeguarding officers nominated by service providers and provided with additional training.
• Implementation planning for a revision by the HSE of its operational adult safeguarding policy which is expected to extend the policy beyond the social care pillar and to all HSE and HSE-funded services.

• A high-level inter-sectoral Steering Group was established to assist the Department in its development of the policy.
• The Department commissioned the Institute of Public Health (IPH) to undertake focus groups with cohorts of health and social care service users who may be affected by the national adult safeguarding policy for the health and social care sector, to ensure their voices are heard during policy development. A total of 12 focus groups were held, with 82 participants in 4 cohorts (including nursing home residents), between November 2019 and March 2020. The report was published in February 2021.
• The Department engaged with other key stakeholders in relation to the development of the national sectoral policy and the resulting output pack detailing stakeholders’ feedback is posted on the Department’s website.
• An independent international research evidence review to inform the policy for the sector was commissioned by the Department and published in February 2021.
• These reports, together with updates and related papers such as presentations to the Steering Group and discussion papers on the policy content, are published on the Department's website and can be accessed at www.gov.ie/en/publication/2861af-adult-safeguarding/.