Vol. 562 No. 6
9 Mr. Deenihan asked the Minister for Health and Children the reason applications for enhanced subvention in the Southern Health Board Region have not been processed since June 2002; if his attention has been drawn to the financial hardship this is causing many families; and if he will make a statement on the matter. [6736/03]
Under the Health (Nursing Homes) Act 1990 health boards provide subventions to assist persons in meeting the costs of nursing home care. Successive Governments have indicated it was never intended that subventions would meet the full costs involved. Apart from arrangements entered into under Article 22.3 of the Nursing Home (Subvention) Regulations 1993, which allows a health board enter into an arrangement with a private nursing home, the placement of a person in a private nursing home and the fees charged is a private arrangement between the nursing home and the individual resident.
A health board may pay more than the maximum rate of subvention relative to an individual's level of dependency, for example in cases where personal funds are exhausted. Articles 22.3 and 22.4 of the Nursing Home (Subvention) Regulations 1993 permit health boards to contract beds in private nursing homes and to pay more than the maximum rates of subvention.
While total expenditure on the nursing home subvention scheme was just over €30 million in 1998, it will amount to almost €110 million in 2003, an increase of 267%.
The board of the Southern Health Board received a significantly increased number of claims from patients for enhanced payments. It is a matter for the board to determine the extent to which it could meet such claims consistent with its requirement to live within its overall revenue allocation and taking account of the fact that such enhanced payments are discretionary. However, in the interest of avoiding hardship to individual patients, my Department has been in regular contact with the board in an effort to find a solution.
I am advised by the Southern Health Board that there are currently 518 people on a waiting list for enhanced subvention. Of these, 190 have received an enhancement and are awaiting further enhancement, 174 are in receipt of basic subvention plus an additional allocation under Article 10.6, and 154 are in receipt of basic subvention alone. There are currently 530 people in receipt of enhanced subvention and the average enhanced payment is €364.34 per week. The average enhanced rate of subvention payable in the Southern Health Board area is considerably higher than the rates payable in other health board areas. The Southern Health Board has also an over-reliance on private nursing home beds because of a shortage of public long-stay beds and I hope the PPP programme being piloted in the Cork area will address this problem.
I am advised by the Southern Health Board that it reviews the position regarding enhancements on a weekly basis and that it is kept under review. The board has informed my Department that it has continued to process applications for enhanced subvention since June 2002 and there is, therefore, no basis for the claim that applications are not being processed.
The Minister and I debated this at some length last night and the night before. Everybody is aware that subventions were never intended to carry the full cost of nursing home care, but when the scheme was introduced ten years ago, it contributed 60% of the cost. That is now down to a quarter of the cost in Dublin and about a third of the cost nationally. It is causing enormous hardship and in some cases intolerable conditions for families.
The Minister says enhanced subvention is a discretionary scheme. While this is true in law, it is not being requested for the sake of avoiding hardship, it is being requested because there is no alternative. Without this subvention people would be evicted from nursing homes into the care of nobody in many cases. That cannot be allowed to persist. Is the Minister aware of how extreme the problem is, not just in the Southern Health Board area but also throughout the country? Health boards are so strapped for money that they are delaying the processing of ordinary subventions to which people are entitled.
I am very familiar with the need for long-stay beds and that is why there has been recognition of the need to commence some PPP programmes. I am not aware of anybody being evicted from private nursing home care because of a lack of an enhanced subvention and I would be seriously concerned if any such incidents took place.
People are receiving letters, which is very disturbing for them.
I am satisfied with the enhanced subvention and the contract arrangements currently in place. Should the Deputy be aware of anybody who is being evicted, I would be very anxious to hear about it.
I can send the details on to the Minister personally. How can the Minister say he is very happy the existing arrangement with contract beds is still working? It is not working. Contract beds are being withdrawn from the system all the time, and that has been particularly so since last June. I never dispute that more money is being spent, but the reality is the number of patients being catered for with either contract beds, enhanced subventions and even subventions is declining.
I repeat that €110 million is being spent on subvention this year. I am aware that some alignment is taking place in relation to the contractual arrangements for beds by certain health boards, which may result in the withdrawal of contractual beds in one area. However, these are then reallocated to the area in which the board is spending its money. This is particularly true of the three area boards under the Eastern Regional Health Authority. Overall, there should be more beds in the system.
