Dáil Éireann debate -
Tuesday, 30 Jan 2001

Vol. 529 No. 1

Written Answers. - Nursing Home Subventions.

Richard Bruton

Question:

515 Mr. R. Bruton asked the Minister for Health and Children the aspects of health board practice in relation to the assessment of means for nursing home subvention that have come under criticism by the Ombudsman; his views on the propriety of such practices; if he is arranging a refund of money to all those families affected by unlawful practices; and if he will make a statement on the matter. [2655/01]

Jack Wall

Question:

544 Mr. Wall asked the Minister for Health and Children if he is examining newspaper allegations regarding Alzheimer's patients and nursing home subvention payments by patients; the methods an applicant can use to obtain a refund, if due; the rules and regulations which will be put in place to ensure that such occurrences will not recur; and if he will make a statement on the matter. [1108/01]

Gay Mitchell

Question:

552 Mr. G. Mitchell asked the Minister for Health and Children if he will make a statement on the role of his Department following revelations in a newspaper (details supplied) that some elderly residents of nursing homes had been illegally overcharged for services and that the income of family members who did not reside with their elderly parents before admission was illegally included in income assessment for purposes of determining subvention; the amount paid to each health board; the amount of refunds paid out by each health board; the amount still outstanding in each health board; and if he will issue guidelines regarding the charges for which a patient is liable in a public bed or a private bed in a nursing home. [1152/01]

Michael Ring

Question:

558 Mr. Ring asked the Minister for Health and Children if he will instruct the health boards to repay money due to the families of subvention recipients; when this money will be repaid; the number of people owed money in each health board region; and the total amounts due in each region. [1224/01]

Jack Wall

Question:

581 Mr. Wall asked the Minister for Health and Children if he has received any applications for refunds as a result of newspaper reports with regard to nursing home hospital subvention payments; and if he will make a statement on the matter. [1339/01]

Nora Owen

Question:

642 Mrs. Owen asked the Minister for Health and Children the action he is taking arising from the Ombudsman's report on the way in which some health boards did not pass on moneys to people in nursing homes but used it for other purposes; if he will condemn such actions and compensate the affected people; and if he will make a statement on the matter. [1652/01]

Dan Neville

Question:

654 Mr. Neville asked the Minister for Health and Children if he will make a statement on the assessment of children's incomes when calculating nursing home subvention; and if he will refund those patients or their families where subvention was refused or reduced. [1719/01]

Dan Neville

Question:

655 Mr. Neville asked the Minister for Health and Children the practices by health boards which deprived nursing home patients of the £11 per week pocket money from their pensions; the procedure to be adopted to refund the patients concerned; and if he will make a statement on the matter. [1720/01]

Paul McGrath

Question:

697 Mr. McGrath asked the Minister for Health and Children if all moneys paid by his Department to each health board in 1998 by way of a fund to repay pensioners within their care has been expended by each health board; if not, the balance in each health board; if health board auditors made any reference to these balances in their auditors' statements; and if he will make a statement on the matter. [2069/01]

Frances Fitzgerald

Question:

726 Ms F. Fitzgerald asked the Minister for Health and Children the action he will take in view of revelations in a recent newspaper (details supplied) to deal with the threat that health boards took money inappropriately from nursing home patients in their care; and if he will make a statement on the matter. [2355/01]

Minister for Finance (Mr. McCreevy): I propose to take Questions Nos. 515, 544, 552, 558, 581, 582, 642, 654, 655, 697 and 726 together.

I understand that the final report of the Ombudsman on the operation of the nursing home subvention scheme, a draft of which has been the subject of media reports referred to by Deputies, is being published this afternoon and Deputies will appreciate that I am not in a position to respond in detail until I have had an opportunity to have the findings of the report fully examined in my Department. I can, however, inform Deputies of a number of steps taken to remedy shortcomings in the subvention scheme in so far as they adversely affected people in nursing homes and their families.

Deputies have raised the issue of the payment of refunds to subvention recipients or their families arising from the incorrect application of Article 8.2 of the Nursing Home Subvention Regulations, 1993, which allows health boards disregard a sum equivalent to 1/5 of the old age non-contributory pension when assessing means and calculating the amount of subvention to be paid. The making of payments arising from the assessment of family circumstances has also been raised.

In relation to the operation of Article 8.2, an additional allocation of £4 million was made available in the 1998 letters of determination to six of the eight health boards, where the regulations were applied incorrectly, to meet the costs of arrears payments in respect of the full implementation of the Health (Nursing Homes) Act, 1990, and subsequent regulations. The breakdown of this allocation was as follows:

Board	£
Midland Health Board	300,000
Mid-Western Health Board	950,000
North-Western Health Board	830,000
Southern Health Board	560,000
South-Eastern Health Board	610,000
Western Health Board	750,000
Total	4,000,000

I should explain that the sum of £4 million was not provided solely for the purposes of Article 8.2 arrears. Health boards were also incurring additional expenditure as a result of the easing of family circumstances regulations in 1996. The funding was intended to address both problems and to meet funding shortfalls in the scheme generally.

Following a meeting with the Office of the Ombudsman in December 1999, the Department became aware of continuing delays in paying arrears. The Department took the matter up with the relevant boards and is continuing to pursue the matter. The current position is that where arrears were due to be paid, health boards have made retrospective payments in respect of persons currently resident in nursing homes. Some boards have also paid arrears in respect of former subvention recipients now deceased and former recipients who are no longer resident in nursing homes. The Department has instructed the relevant boards to take immediate steps to pay all outstanding arrears. To date a total of approximately £900,000 has been paid out in respect of Article 8.2 arrears. It is not possible at this stage to give a figure for the total cost of Article 8.2 arrears payments as a number of boards have not as yet completed the process of calculating the amounts due. I assure Deputies that every effort will be made to pay all outstanding arrears as soon as possible and I have instructed my Department to pursue this with the health boards concerned.

Deputies also raised the issue of how the £4 million allocated in 1998 was used by health boards. As I indicated, this allocation was not intended to be used solely for the payment of Article 8.2 arrears. The Department has been informed by the health boards concerned that the funding provided was used to cover arrears payments under Article 8.2; additional expenditure arising as a result of the easing of the family circumstances regulations in 1996; the payment of enhanced subventions; expenditure shortfalls arising from increasing demands under the scheme and legal and other costs associated with the administration of the scheme. A proportion of the allocation was used by three of the health boards to fund other services for older people i.e. the provision of aids and appliances, mainly incontinence wear, improved home help services and the opening of a unit for the elderly mentally infirm. While this money was not expended on the subvention scheme, it was used for the benefit of older people.

I also wish to inform Deputies that arrangements are being made to make appropriate payments in respect of nursing home patients and their families who may have been affected by the family circumstances regulations prior to their amendment in 1999. This amendment removed the provision which allowed health boards assess the capacity of adult sons and/or daughters over 21 years of age to contribute towards the cost of nursing home care of their parent. A group representing the Department and the health boards/ERHA has been established to ensure that this process is carried out on a uniform basis. As this will be a complex exercise involving difficult issues of traceability, it may take some time to complete. Nevertheless, every effort will be made to make payments as quickly as possible. I should add that the legal advice available to me is that there is no legal liability on the State to make retrospective payments in relation to family circumstances. Nevertheless, in the interests of fairness to the people concerned, the Minister and I have decided on this course of action.

The findings contained in the Ombudsman's final report will be fully considered by my Department. An expenditure review of the scheme is currently being undertaken by my Department in association with the Department of Finance and is expected to be completed shortly. It is my intention to bring forward proposals to Government in relation to whatever additional measures may be necessary arising from these reports and experience gained from the operation of the scheme since its inception in 1993.

I would like to emphasise again that the immediate priority is to ensure that shortcomings which adversely affected nursing home patients and their families are addressed. The steps which I have outlined to the House in relation to the calculation and making of payments by health boards will I hope reassure Deputies that this matter is being given the highest priority.