Eoin Hayes (Dublin Bay South, Social Democrats)
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408. To ask the Minister for Health if any review has been carried out on the fair deal scheme, its effectiveness in providing care to the elderly and infirm, the assessed value for money of the scheme and any gaps in the scheme, such as where it affects the future or current care needs of another individual in the family, that she plans to address; and if she will make a statement on the matter. [22704/25]

Kieran O'Donnell (Limerick City, Fine Gael)
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The Nursing Homes Support Scheme (NHSS), more commonly referred to as 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. Participants within the NHSS contribute up to 80% of their income (40% if part of a couple) and 7.5% per annum of the value of their assets (3.75% if part of a couple). The first €36,000 (€72,000 if part of a couple) is excluded from assessment. The value of a person's principal residence is only assessed for contributions for their first three years on the scheme.

The NHSS supports approximately 24,000 long term residents.

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.

Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. Under the terms of the NHSS Act 2009, private nursing homes should not levy additional charges on NHSS residents for services coming within scope of the Nursing Homes Support Scheme.

A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home.

All nursing homes, as registered providers with the Health Information and Quality Authority (HIQA), have well-established obligations under the legal framework in terms of the delivery of safe care to residents. HIQA is the statutory independent regulator for this sector and this responsibility is underpinned by a comprehensive quality framework comprising of Registration Regulations, Care and Welfare Regulations and Quality Standards.

In discharging its duties, HIQA determines through examination of all information available to it, including site inspections, whether a nursing home meets the regulations in order to achieve and maintain its registration status.

In its capacity as the independent regulator of the nursing home sector the decision to carry out an inspection of a particular nursing home and the frequency with which inspections occur at that same facility, is a matter for HIQA to decide. Whilst HIQA has no legal role in examining individual complaints, the Authority does take into account all information it receives, including complaints from the public, when carrying out inspections and this range of information informs a risk-based approach to regulation.

HIQA will always work closely with nursing homes providers to ensure compliance plans are in place to deal with the issues raised in their inspection reports.

The Department of Health is fully supportive of HIQA and their capacity to visit any long-term residential care facility to ensure that the best practices are being implemented and the best supports are being provided to older people.

Since Fair Deal was introduced in 2009 approximately €14 billion has been spent on the NHSS. Every year since 2017 has seen significant year on year increases in the NHSS budget. The Department of Health has secured year-on-year funding increases for Fair Deal, that has seen the budget increase from €968 million in 2019 to €1.221 billion for 2025. The scheme is also part-funded by residents’ contributions, which amount to approximately €300m each year.

Over the life of the scheme over 300,000 people have benefitted from Fair Deal.

In 2015 a comprehensive review of the operation of the Nursing Homes Support Scheme was completed and subsequently published. The review can be found by following this link: www.gov.ie/en/publication/6f512a-review-of-the-nursing-homes-support-scheme-a-fair-deal/.

The Nursing Homes Support Scheme Review (2015) identified a number of recommendations for immediate implementation and a number of other complex issues that were deemed to require more detailed consideration. There are currently no plans to conduct a similar root and branch review of the scheme.

Emerging from this review, several subsequent reviews and actions incorporating different elements of the Nursing Homes Support Scheme have been completed.

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 between public and private/voluntary nursing homes 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. The Value for Money Review can be found by following this link: www.gov.ie/en/publication/3859f-a-value-for-money-review-of-nursing-home-care-costs/.

The Department of Health published a review of the National Treatment Purchase Fund (NTPF) pricing system in June 2021 and continues to work on bringing forward the recommendations that emerged from this review. This review can be found by following this link:

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. The group made four recommendations which are being progressed by the NTPF and the Department of Health.

In addition, the Covid-19 Nursing Home Expert Panel’s recommendations have provided a guiding framework not only for the pandemic response in nursing homes over the course of the Covid pandemic but also more broadly for a wide-ranging programme of improvement and reform for older persons’ care. Its recommendations are implicitly considered in the existing reform framework for the NHSS, comprising the recommendations of this review, the Pricing review, the C&AG review and successive Programme for Government commitments.

Given the size, complexity and cost of the NHSS, implementation is complex and any changes in policy direction need to be carefully assessed and continuously appraised. 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.