Dáil Éireann debate -
Wednesday, 7 May 2003

Vol. 566 No. 1

Written Answers. - Nursing Home Services.

Mary Wallace

Question:

517 Ms M. Wallace asked the Minister for Health and Children if his Department's attention has been drawn to the national nursing homes organisation's recent statement that there are 500 empty private nursing home beds in the greater Dublin area; if the Eastern Regional Health Authority area plan is to provide an additional 500 public nursing beds in the greater Dublin area; if it is expected that these beds would cost ?50,000 to ?60,000 per annum from the State compared with ?40,000 for the private nursing home bed; if he could make a statement on the accuracy of these statistics; the way in which this could be economical; if this position will be reviewed leading to greater co-operation between the public sector and the private sector due to the huge cost factor for the State; and if he will make a statement on the matter. [12176/03]

Minister of State at the Department of Health and Children (Mr. Callely)

As the Deputy may be aware, private nursing homes are private ventures and vulnerable to market forces. My Department does not routinely collate information on the number of beds available in private nursing homes but does monitor the situation on an ongoing basis.

Public private partnerships, PPPs, are being piloted in the Eastern Regional Health Authority and Southern Health Board areas. It is anticipated that 17 new CNUs will be developed under the PPP initiative and that a maximum of 850 new long-stay beds for older people will be provided, 450 of these in the ERHA area and 400 in the Southern Health Board area. The services offered in these units will include assessment-rehabilitation, respite, extended care and convalescence.

Day care centres for older people will form an integral part of each CNU site to help promote the dignity and independence of older people and to support them with living at home. Business advisers have been appointed to the projects and are engaged in preparing an outline business case. It is not possible to be precise at this stage about the cost per bed of the proposed new developments. However, given the range of services and facilities to be provided in the CNUs, both the capital cost and running costs are not comparable to those of private sector nursing homes.

With reference to the cost of a private nursing home bed compared with the cost of a long-stay bed in a public facility, not all beds available in private nursing homes may be suitable for patients because of their location or because the nursing home may not be in a position to meet the nursing and care needs of particular patients. In addition, public long-stay facilities often provide a range of services for older people such as physiotherapy, occupational therapy, chiropody, speech therapy, psychology services, social work services, public health nurse services and day care services. Not all these services are available to older people in the private nursing home sector on a regular basis. The cost of medical input is not, to my knowledge, included in calculating the cost of a private nursing home bed while it would be a factor in the overall cost of a bed in a public extended care facility. Therefore, the cost comparisons are not on a like-for-like basis.

My Department and the health boards regularly engage with the private nursing home sector in the provision of nursing home services for older people.

Mary Wallace

Question:

518 Ms M. Wallace asked the Minister for Health and Children if the statistics (details supplied) are correct with regard to the elderly in acute beds in general hospitals in the Dublin area who could be moved to nursing home beds if the funding was provided; if the economics of the situation have been addressed by the officials in his Department where the national treatment purchase fund is being used to pay for services abroad, where the work could be carried out if the acute beds were freed up by the same funding being provided to transfer the elderly patients to Irish nursing homes; if he will consider carrying out a review by his Department of these factors; and if he will make a statement on the matter. [12177/03]

Minister for Health and Children (Mr. Martin)

Responsibility for the funding of services at the hospitals referred to by the Deputy rests with the Eastern Regional Health Authority, ERHA. Therefore, my Department has asked the regional chief executive of the authority to investigate the position in relation to the number of elderly persons in acute hospitals who could be moved to a more appropriate setting and to reply directly to the Deputy.

The national treatment purchase fund, NTPF, is one of the key actions for dealing with public hospital waiting lists arising from the health strategy, Quality and Fairness – A Health System for You. Health boards and hospitals have been asked to identify public hospital patients waiting longest on in-patient lists in order that they can be offered treatment under this initiative where capacity is not readily available in the public sector. Capacity is sourced by the NTPF, mainly from private hospitals in Ireland, with some additional capacity also having been identified in the United Kingdom. Approximately 4,000 patients have been treated by the NTPF to date. I am satisfied that the NTPF is making an important contribution to the reduction of hospital waiting lists and I have no plans to redirect its funding to other services.

Mary Wallace

Question:

519 Ms M. Wallace asked the Minister for Health and Children the length of time the capital allowance tax relief for nursing homes has been in place; the way in which it has been effective in establishing sufficient beds, and the controls there are to ensure appropriate location in terms of supply and demand; if there is a danger of over-supply in some locations and under-supply in the market while having the benefit of reduced fees could also lead to reduced quality of care as the cost would have to meet the reduced income; the role the health board can play with regard to reasonable purchasing of quality beds for the patients; if his Department has plans for revised standards and procedures to ensure that all health boards are working to the same criteria in terms of quality and that, while the cost is a factor, it should not be the only determining factor; and if he will make a statement on the matter. [12178/03]

Minister of State at the Department of Health and Children (Mr. Callely)

The system of capital allowances for nursing homes registered with health boards was introduced in the budget of 1998 by my colleague, the Minister for Finance, and my Department does not have information on the number of nursing home proprietors who took advantage of these allowances.

My Department has no control over the location of new private nursing home developments as such projects are developed by the private sector. However, my Department would, as a matter of course, advise potential private nursing home proprietors, where such advice is sought, to contact the relevant health board for the area in which the proposed nursing home is to be located for advice on the statutory requirements for registration under the Health (Nursing Homes) Act 1990. Private nursing homes, as commercial enterprises, are subject to local market forces in relation to bed occupancy rates.

The placement of a person in a private nursing home and the fees charged to that person are a private arrangement entered into between the nursing home and the individual. However, health boards are entitled under Article 22.3 of the Nursing Home (Subvention) Regulations 1993 to contract beds in private nursing homes.

Standards of care in private nursing homes are governed by the Nursing Homes (Care and Welfare) Regulations 1993. My Department is reviewing the Health (Nursing Homes) Act 1990 and the Nursing Home (Subvention) Regulations 1993 to determine their relevancy and efficacy in providing long-term care to the elderly. The objective of the review is to develop a scheme which will be transparent, offer a high standard of care for clients, provide equity within the system to include standardised dependency and means-testing, be less discretionary, be consistent in implementation throughout the country and draw on experience of the operation of the old scheme.