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Dáil Éireann debate -
Thursday, 20 May 2010

Vol. 709 No. 4

Care of the Elderly

I thank the Ceann Comhairle for allowing me to raise the important matter of Health Information and Quality Authority, HIQA, inspection charges being passed on to individual residents of nursing homes, in direct contravention of the stated policy of the Government as set down by the Minister of State, Deputy Áine Brady, in this House on Wednesday, 4 November 2009. The announcement in March last year of national quality standards for residential care settings for older people was widely accepted as being an important step in protecting the rights of elderly people accessing residential care services throughout the country. The aim of introducing regulatory standards is to monitor the standard of care and improve the quality of life for older people in residential care settings. In the light of several recent high-profile cases in which standards were shown to be inadequate and the care given to vulnerable older people way below what was acceptable, the legislation under the Health Act 2007 was timely.

At the time these standards were introduced, it was stated the inspection fee was not due or payable by individual residents or their families. We have been repeatedly told since that payment of these charges was a matter between the authority and nursing home providers. As such, I am concerned about complaints from the families of individual residents of a nursing home that they are being invoiced directly for these HIQA inspection charges. Before raising this matter in the House, I contacted representatives of HIQA and the nursing home in question. HIQA has categorically stated the charges were never intended to be passed on to the families of individual residents.

To my dismay, however, the nursing home in questin has provided written confirmation that it is directly invoicing individual residents for the charges and is doing so on the basis of comments made by the Minister for Health and Children, Deputy Mary Harney, at the press conference at which the national quality standards were launched on 9 March 2009. According to nursing home management, the Minister said in response to a question from a journalist that she accepted that the charges would "clearly be passed on".

There is clearly a divergence of opinion between HIQA, the Minister for Health and Children, the Minister of State, Deputy Brady, and residential care providers as to how these charges are to be paid. This matter is sufficiently important as to require the Minister or her representative to come to House and clarify the matter once and for all.

The Government places great importance on the policies and practical reforms we are implementing to ensure patient safety and quality assured health services. I assume the registration and inspection fee Deputy is referring to is in respect of designated centres or nursing homes for older people.

The Health Act 2007 provides for the registration and inspection of all nursing homes. Inspections are carried out by the Chief Inspector of Social Services, part of the Health Information and Quality Authority. It is important to have effective mechanisms to maintain and enhance public confidence in the delivery of quality residential care. Residents, their families and members of the public need to be reassured that the authority is monitoring the care people receive. It is important, therefore, to have an effective, robust, independent and properly resourced inspection regime for residential services for older people. This involves substantial costs on the Exchequer and it was considered appropriate that these costs should largely be met by the service providers.

Accordingly, it was decided that the fees to be charged by HIQA to such providers, including those operating in both the public and private sectors, should be largely on a self-funding basis. Such fees are provided for in the Health Act 2007.

The Department of Health and Children examined HIQA's estimates of the resources it would require to carry out the registration and inspection function. As a result, it was estimated that the minimum additional annual funding required would be €4.5 million. This covers staffing costs for the inspectorate. Capital and other operational costs will, for the time being, be met within HIQA's overall existing allocation.

Since 1 July 2009 all nursing homes, public and private, are registered under the Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2009 by the chief inspector. All nursing homes, public and private, will also be inspected under the new care and welfare regulations and patient focused quality standards. Since this date nursing homes pay an annual fee of €190 per place and a registration fee of €500 every three years for the registration and inspection regime of the authority. This constitutes an average weekly cost of €3.73 per registered place. Effectively, nursing homes contribute to the cost of regulation as a normal business cost, as occurs in other regulated sectors.

The fees are payable by the registered provider or are to be included by an applicant when applying for registration. Residents should only be charged those fees set out in their agreed contract with the provider.

My colleague, the Minister for Health and Children, is aware that, as with many other sectors, there are financial pressures in the nursing home sector. In this regard, she was pleased, at the suggestion of nursing home owners, to include in regulation a mechanism for the annual fee to be paid by the registered provider in three equal instalments each year to help address this issue.

As I am sure the Deputy will agree, lessons had to be learned from well publicised incidents in nursing homes in recent years and reports such as that of the Leas Cross commission of investigation published only last year. This new system of regulation and inspection, which was introduced in July 2009, is to underpin quality and safety for residents in nursing homes. We have also introduced a new system of financial support, fair deal, for residents in all nursing homes from last October to ensure access is affordable and anxiety free for all. In this context, the Government considers it reasonable that the nursing home sector should contribute towards these important developments in assuring quality care for some of the most vulnerable people in our society.

If Deputy Behan provides me with details of a specific case, I will have it investigated on his behalf.

The Deputy is having a good day.

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