Written Answers Nos. 431-438
431. Deputy Fergus O'Dowd asked the Minister for Health further to Parliamentary Question No. 269 of 11 May 2023, if he will provide further details on the internal HSE TAPS audit referred to; the date it was received by the HSE, and him and his Department; the results and recommendations of this audit; when his Department intends to publish the final audit; and if he will make a statement on the matter. [23685/23]
View answerThe COVID-19 Temporary Assistance Payment Scheme (TAPS) was established in April 2020 in response to a public health emergency to provide support to private and voluntary nursing homes to mitigate and respond to the impacts of COVID-19. The core concept of the scheme when it was established was that the State would provide additional funding to those nursing homes that require it to contribute towards costs associated with COVID-19 preparedness, mitigation and outbreak management.
The scheme was established on an administrative basis and guidelines were issued by the HSE setting out allowable and non-allowable costs and a robust regime of overall controls.
Scheme payments were based on vouched expenditure, meaning that all claims were for COVID-19 related costs incurred by nursing homes and supported by financial information. Each nursing home’s monthly claim was capped depending on size, up to an overall maximum of €60,000 per month. All claims were reviewed and validated, with avenues for escalation and query where needed.
All applications may be audited for a period of six years, and any unallowable applications paid or claims that cannot be vouched can be clawed back. Under the terms of the COVID-19 Temporary Assistance Payment Scheme for Nursing Homes, each nursing home seeking support under the arrangement agreed that its application would be subject to audit.
Under the terms of the scheme the NTPF or the HSE would, on a sample and/or risk basis, carry out formal audits of claims made retrospectively and would be supported in this work by professional auditors. In return, nursing homes applying to the scheme needed to provide vouched evidence of COVID-19 expenditure as any expenditure that could not be vouched would be deducted from future claims or NHSS payments. Nursing homes are obliged to retain records for a minimum period of 6 years.
Over €149 million has been claimed by nursing homes under the Temporary Assistance Payment Scheme (TAPS) since its introduction. The Outbreak Assistance element of the scheme was extended, with a gradual reduction of the threshold for maximum monthly claim amounts applying to claims from 01 March 2023. The scheme ceased at the end of April 2023. This approach takes account of the changed situation with regard to COVID-19 in Ireland, and the inherently temporary nature of the scheme.
In relation to the specifics of the questions asked, I have asked the HSE to respond to you directly.
432. Deputy Sean Sherlock asked the Minister for Health his views on the proposed closure of the fair deal scheme at a nursing home in Cork (details supplied). [23686/23]
View answer433. Deputy Sean Sherlock asked the Minister for Health if he will respond to a concern relating to the fair deal scheme (details supplied).; and if he will make a statement on the matter. [23695/23]
View answer434. Deputy Sean Sherlock asked the Minister for Health if he will respond to a concern relating to the fair deal scheme (details supplied). [23696/23]
View answer435. Deputy Sean Sherlock asked the Minister for Health if he will respond to a concern relating to the fair deal scheme (details supplied). [23697/23]
View answer436. Deputy Sean Sherlock asked the Minister for Health if he will respond to a concern relating to the fair deal scheme (details supplied). [23698/23]
View answer447. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if he is aware of the situation facing residents (details supplied); the action he proposes to take to ensure that the residents are protected and can remain in place; and if he intends to ensure the HSE re engages to find a fair solution. [23769/23]
View answerI propose to take Questions Nos. 432, 433, 434, 435, 436 and 447 together.
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.
Overall, 425 private nursing homes negotiate with the National Treatment Purchase Fund (NTPF). Minister Butler and the Department of Health has 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. 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.
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.
Budget 2023 saw an 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.
Private and most voluntary nursing homes agree the price that they can charge for a Fair Deal resident 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 such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. Neither Minister Butler nor Minister Donnelly has any role in this negotiation process.
The NTPF carries out this role independently under the Nursing Home Support Scheme Act 2009 and the Department of Health published a review of the NTPF pricing system in June 2021.
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.
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. Last year, 4,500 residents were in these public CNUs.
As I understand, engagement continues between the private provider referenced in the details supplied and the NTPF.
437. Deputy Bernard J. Durkan asked the Minister for Health the up-to-date position regarding a current medical card in the case of a person (details supplied); and if he will make a statement on the matter. [23699/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
438. Deputy Brendan Howlin asked the Minister for Health if he will intervene to ensure an early appointment with the outpatient ENT Clinic in Waterford University Hospital for a child (details supplied) who has been told that the waiting time for an appointment is up to four years, and whose hearing is significantly disimproving; and if he will make a statement on the matter. [23700/23]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
