Éamon Ó Cuív (Galway West, Fianna Fail)
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1182. To ask the Minister for Health the reason that the State subvention of private and public nursing homes varies across the State and between whether they are in public or private ownership; the objective criteria used to calculate these subventions; whether it is intended to reform the system; and if he will make a statement on the matter. [44780/24]

Mary Butler (Waterford, Fianna Fail)
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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 operated Community Nursing Units (CNUs) generally having a higher cost of care.

In December 2021, the Department published the independently chaired Value for Money (VFM) 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 VfM Review made nine recommendations which the Department continues to take forward.

It is also important to note that the HSE has a statutory function 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. The HSE needs to be equipped to deliver all manner of complex care. The HSE will support families in a situation where a private nursing home is no longer able or willing to provide care under Fair Deal to a loved one. Residents in HSE-run Community Nursing Units (CNUs), which are often staffed at a level that allows the delivering of more complex care where required, represent less than 20% of Fair Deal scheme participants.

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 Homes Support Scheme Act 2009.

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 and are 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 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 managed by the HSE, and maximum prices in private centres under section 40 and section 41. It should be noted that, as per the provision of the 2009 Act, the HSE determines the cost of care in public nursing homes and do not engage in the with the NTPF in matters related to costs.

The NTPF is the designated state agency tasked with agreeing the maximum prices for individual nursing homes which participate in the Nursing Home Support Scheme (NHSS). Maximum prices are agreed with private and voluntary nursing homes based on the NTPF’s cost criteria, such as costs incurred by the nursing home, local market prices, historic prices and overall budgetary capacity.

The NTPF carry out this role independently under the Nursing Homes Support Scheme (NHSS) Act 2009. The NTPF has statutory independence, and there is no role for Ministers or the Department of Health in this process.

It is important to note that the amount a nursing home resident pays towards the cost of their nursing home care under the NHSS is calculated based on the value of their assets and income when they apply for nursing home care.

Regardless of whether a person resides in a publicly run Community Nursing Unit or a private/voluntary operated nursing home their contribution to the cost of their own care is calculated under the same criteria, therefore the cost to the resident remains the same.

The Productivity and Savings Taskforce was established in January 2024. The Minister for Health requested the Secretary General of the Department of Health and the CEO of the Health Services Executive to co-chair a programme to drive savings and productivity improvements across the HSE.

A key action is to secure a reduction in the cost of care in HSE Long Term Residential Care Facilities for Older People. The Taskforce will provide monthly updates to the Minister for Health.

The Department of Health also 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 these recommendations; this group has met on a regular basis since publication of the review.

The terms of reference for the group include a final report to be submitted to ministers, reporting on delivery of the four recommendations and making any further recommendations as appropriate. It is my understanding that this report is at an advanced stage.