Dáil Éireann Debate, Tuesday - 4 October 2022
618. Deputy Alan Dillon asked the Minister for Health the steps that the HSE has taken alongside the Department of Health and the National Treatment Purchase Fund to address the cost-differential between private and public nursing homes, following a value-for-money review including nine recommendations; and if he will make a statement on the matter. [48096/22]
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 nursing homes generally having a higher cost of care to the Exchequer. However, it is important to note that regardless of whether it is a private, voluntary or public nursing home, the resident's financial contribution is the same; the price of care only affects levels of state funding and has no direct impact on the resident. A Value for Money (VFM) Review on Nursing Home Care Costs was undertaken between March 2018 and March 2021 under the direction of a Steering Committee comprising representatives of the Department of Health, the Department of Public Expenditure and Reform (DPER), the National Treatment Purchase Fund (NTPF), the Health Service Executive (HSE), and the Economic and Social Research Institute (ESRI), led by an independent chair. 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. The review was published in December 2021 and can be viewed by following this link: www.gov.ie/en/publication/3859f-a-value-for-money-review-of-nursing-home-care-costs/ 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 NHSS. The report 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. 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 VFM Review made nine recommendations which the Department continues to take forward. It should be noted that many of the recommendations from the report were already in progress and overlap with existing workstreams.
- The Department has set out a plan for how each of the recommendations will be addressed and by which organisation. Progress against these recommendations will be monitored through existing NHSS oversight structures.
- The Department continues to engage with the NTPF on a range of topics in respect of data sharing and analysis - the additional types of data that might be required to inform future policy-making is still being considered.
- Funding has been secured for an additional 128 InterRAI Single Assessment Tool care needs facilitators and recruitment has commenced. The Department intends that InterRAI Single Assessment Tool will be rolled-out to long-term residential care when the initial phase of recruitment is complete.
- The respective home support and residential care policy teams within the Department are currently engaging to evaluate the testing of a reformed model of service delivery that will provide the basis for the development of a system of care banding. Testing is ongoing in four pilot sites and an interim report is expected in November.
- Significant progress continues to be made in relation to Safe Staffing and Skill Mix Framework for Residential Care and will continue throughout 2022 with a view to developing national policy. The Department expects policy implementation to commence in 2023.
- Terms of reference for an extensive review and audit process of the public cost of care, while still under development, are temporarily paused to allow the HSE complete their own ongoing audit of public bed capacity. Nevertheless, the Department expects to be able to commission an independent review in the latter part of the year.
- The HSE have committed to publishing a list showing the actual eligible costs, highlighting any variances against the maximum cost of care, incurred by each nursing home in respect of the calendar year 2022 onwards.
- The Department of Health and the HSE continue to work on a number of initiatives to support both the discharge of patients from an acute setting and demand from the community, depending on the assessed care needs of the individual client/patient. It is expected that a review of the impacts of these initiatives will be concluded by the end of 2022.
- The Government is committed to the implementation of the 86 COVID-19 Expert Panel recommendations. While it is accepted that this broad programme of wide-ranging and complex reform will take time to implement, the fourth progress report on the implementation of the recommendations, published in June 2022, highlights the important progress that has already taken place across a number of areas and sets out clearly the structures and processes that have been established to ensure continued implementation.
