Dáil Éireann Debate, Thursday - 1 June 2023
352. Deputy Éamon Ó Cuív asked the Minister for Health how the rates of payment to nursing homes under the nursing home subvention scheme are determined; the reason for the regional disparity between the different rates paid; the reason the rate of payment to HSE-owned nursing homes is considerably higher than to private nursing homes; and if he will make a statement on the matter. [26938/23]
View answerThe 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. In December 2021, the Department of Health published the independently chaired Value for Money (VFM) Review on Nursing Home Costs. The VFM Review sought to identify, quantify and analyse the reasons for any cost differential between private/voluntary and public nursing homes and, following analysis, to make recommendations for improving the value for money obtained by the health sector. Among the issues raised were the pay costs of staff in nursing homes, the dependency levels of residents, energy costs, and medical supplies charges to the Nursing Home Support Scheme. However, the review also found that establishing like-for-like comparisons was complex and not always possible, especially when considering differences in dependency levels.
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. Residents in CNUs, which are often staffed at a level that allows the delivery of more complex care where required, represent just under 20% of Fair Deal scheme participants. Last year, there were 4,500 residents in these CNUs. The HSE needs to be equipped to deliver that kind of complex care. 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. The National Treatment Purchase Fund (NTPF) has been designated by the Minister for Health pursuant to Section 40 of the Nursing Homes Support Scheme Act 2009 as a body authorised to negotiate with proprietors of non-HSE registered nursing homes to reach agreement in relation to the maximum price(s) that can be charged for the provision of long-term residential care services to NHSS residents. Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria. The objective of the NTPF is to agree a price with each nursing home that offers value for money to the State having regard to the following criteria:a) the costs reasonably and prudently incurred by the home and evidence of value for money;b) the price(s) previously charged;c) the local market price; and d) budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public 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. It is imperative that private and voluntary providers continue to engage in the process as set out in the Nursing Homes Support Scheme Act 2009. There is no other mechanism for funding from the public purse for nursing home residents outside the Nursing Home Support Scheme (Fair Deal). 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 Department of Health published a review of the NTPF pricing system in June 2021. 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 and continues to work on taking these recommendations forward. Overall, 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 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. Nursing homes which had a scheduled renegotiation of their Deed of Agreement this year with the NTPF have 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. Nevertheless, 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 available is for nursing home providers to agree a shorter contract duration with the NTPF. The Government is also 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 it is now under review for extension for a second time up until the end of June 2023.
