Written Answers Nos. 165-181
165. Deputy Patrick O'Donovan asked the Minister for Children, Equality, Disability, Integration and Youth when speech and language therapy will resume for a child (details supplied); and if he will make a statement on the matter. [30184/23]
View answerAs this refers to service matters, I have asked the Health Service Executive (HSE) to respond to the Deputy directly, as soon as possible.
166. Deputy Michael Healy-Rae asked the Minister for Health the steps he will take in relation to fair deal rates (details supplied); and if he will make a statement on the matter. [29861/23]
View answer167. Deputy Michael Healy-Rae asked the Minister for Health if he will examine the rates for the fair deal scheme (details supplied); and if he will make a statement on the matter. [29862/23]
View answerI propose to take Questions Nos. 166 and 167 together.
Fair Deal was designed to protect and support vulnerable older people, to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families. Government funding for Fair Deal is to support vulnerable older people at a time in their lives where full-time care is essential.
The Department of Health acknowledges that there are variations in the cost of care across public centres as well as across private nursing homes, with HSE Community Nursing Units generally having a higher cost of care.
In December 2021, the Department published the independently chaired Value for Money review on nursing home costs. The review 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.
The Value for Money 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 reforms.
Overall, €1.4 billion of the total Health Budget was allocated last year to support over 22,700 people under Fair Deal. This will increase to nearly €1.5 billion for 2023, and I am cognisant that the budget has to support all residents under the Nursing Home Support Scheme (NHSS) for the full calendar year.
The Government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups. The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic. Over €150m of financial support has been provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS) and the provision of free PPE and oxygen to private nursing homes continues, costing approximately €75 million to date.
A new €10 million scheme (TIPS) was established last year to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home. Following a recent review this scheme has been extended for a second time to the end of June 2023.
The only mechanism for funding from the public purse for nursing home residents is Fair Deal and it is really important that private and voluntary providers continue to engage in the process as set out in the Nursing Home Support Scheme Act 2009.
The long-established statutory mechanism through which private and voluntary nursing homes are funded was established by the Oireachtas under the Nursing Homes Support Scheme Act 2009. This legislation outlines the process for private and voluntary providers to negotiate the prices for their services with the designated State agency, the National Treatment Purchase Fund (NTPF).
Maximum prices for individual nursing homes are agreed with the NTPF following these negotiations and are based on the NTPF’s cost criteria, such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity.
Under the NHSS Act 2009 the NTPF has statutory independence, and there is no role for Ministers or the Department of Health in negotiations with individual nursing homes. I cannot comment on individual NTPF negotiations and it must be appreciated that this is a matter for each individual nursing home and the NTPF. Nevertheless, it is important that lines of communication are at all times maintained during the negotiation process.
Overall, approximately 425 private nursing homes negotiate with the National Treatment Purchase Fund (NTPF). The Department of Health and I have regular interaction with the NTPF and met them recently to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.
Budget 2023 saw an over €40 million in additional funding for the Nursing Home Support Scheme (NHSS) which will provide for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated. Anyone who has had a scheduled renegotiation of their Deed of Agreement this year with the NTPF has seen a significant uplift.
In addition, other options to support nursing homes are also being explored, such as to help with the often costly nature of compliance for nursing homes under necessary HIQA regulations.
I am conscious of private and voluntary nursing homes that are not scheduled to renegotiate their Deed of Agreement in 2023 and other options are being considered. One of the options under consideration is for nursing home providers to agree to a shorter contract duration with the NTPF.
It is also important to note that the HSE is statutory provider of last resort and will always step in where a resident’s needs are sufficiently complex that they are not able to be cared for elsewhere in the community. The HSE needs to be equipped to deliver that kind of complex care. The HSE will support families in a situation where a private nursing home is no longer able or willing to provide care under Fair Deal to a loved one. Ensuring that the welfare and safety of residents is secured when nursing homes close is of the utmost importance. It is essential that when nursing homes are intending to close or cease participating in the Nursing Home Support Scheme, residents and their families must be consulted with and given appropriate notice so that new homes can be found and they can be moved in a safe, planned way.
Important strands of reform to the nursing home sector are being, or have been, brought forward. The Government remains committed to delivering on:
•The nine recommendations that emerged from the Value for Money Review on Nursing Home Costs,
•The 86 recommendations of COVID-19 Nursing Homes Expert Panel, especially those recommendations related to long-term sectoral reform,
•The four recommendations of the NTPF Review of Pricing System for Long Term Residential Care Facilities, and
•The 16 recommendations of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants.
Work continues within the Department of Health to deliver on all of these recommendations, as well as analysing the outcomes of the Skills Mix and Safe Staffing pilots which will serve to inform future policy.
Given the size, complexity and cost of the NHSS, implementation is complex and any changes in policy direction need to be carefully assessed and kept under review. The Department of Health is consistently seeking to identify improvements and introduce enhancements to the scheme, where feasible, which aims to ensure that long-term nursing home care is sustainable, accessible and affordable for everyone and that people continue to be cared for in the most appropriate settings.
168. Deputy Imelda Munster asked the Minister for Health why no costs are covered by the HSE for the over-eights ophthalmic scheme in CHO 8, Louth and Meath, when fees are partly covered in other CHO areas; and if he will make a statement on the matter. [29863/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
169. Deputy Imelda Munster asked the Minister for Health why there is no over-eights voucher scheme for glasses in CHO 8, Louth and Meath, when there is a voucher scheme or allowance available in other CHO areas; and if he will make a statement on the matter. [29864/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
170. Deputy Imelda Munster asked the Minister for Health if he has plans to introduce a universal national eye care programme for children aged eight to 16 years; and if he will make a statement on the matter. [29865/23]
View answer207. Deputy Marian Harkin asked the Minister for Health if he plans to fast-track the roll-out of a standardised optometrist-led eye care programme for children over eight years; and if he will make a statement on the matter. [30051/23]
View answer209. Deputy Brendan Smith asked the Minister for Health if he will give detailed consideration to the issues raised by a representative organisation (details supplied); and if he will make a statement on the matter. [30056/23]
View answerI propose to take Questions Nos. 170, 207 and 209 together.
Sight testing, eye examinations and optical appliances are provided to medical card holders by ophthalmologists, optometrists and dispensing opticians through the Community Ophthalmic Services Schemes (COSS). Patients may access these services following a referral by a healthcare professional such as their general practitioner.
All children, including those not covered by a medical card, receive a vision screen while in national school from a Public Health Nurse. The Health Service Executive (HSE) provides optical services free of charge to pre-school children and national school children referred from child health service and school health service examinations who are discovered to have sight problems. These children are referred to the appropriate consultant for treatment. In such circumstances, these services will continue to be provided until the child has reached the age of 16.
The HSE Primary Care Eye Services Review Group Report, published in June 2017, highlighted the limitations of the current model of service delivery and set out the way forward for a significant amount of eye services to be delivered in a primary care setting. The Report estimated that 60% of existing outpatient activity could be moved to primary care thus enabling hospital services to focus on patients who require more specialist diagnostics or treatments.
The National Clinical Programme for Ophthalmology has developed a model of care which details how the realignment of eye services from the acute hospitals to the community will be undertaken. Included in current priorities is transferring the care of children aged 8+ years to the care of local private optometrists.
A project team with a wide-ranging membership was established in late 2019 / early 2020 to progress this initiative. The work of the team was paused due to the requirement to focus resources on the COVID 19 pandemic. However, the project team has been reconvened and is progressing matters in relation to this initiative.
As this also involves a service matter, I have asked the HSE to respond to the Deputy directly in regards to progress made, as soon as possible.
171. Deputy Imelda Munster asked the Minister for Health to list the schools in the CHO 8 area that have received and completed, or not received and not completed, public eye care school screening, in tabular form; and if he will make a statement on the matter. [29866/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
172. Deputy Imelda Munster asked the Minister for Health how many children have been referred out to optometrists under the over-eights eye care scheme; how many children were discharged from the scheme without further care in CHO 8, Louth and Meath; and if he will make a statement on the matter. [29867/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
173. Deputy Michael Healy-Rae asked the Minister for Health if he will examine a series of matters in relation to private and voluntary nursing homes (details supplied); and if he will make a statement on the matter. [29870/23]
View answerIt is acknowledged that the nursing home sector has evolved over the last 30 years from a predominantly State led service to a situation today where approximately 80% of nursing home services are provided by the private sector. While it is the Government’s overarching policy to provide a greater level and volume of care in the community and to support older people to live at home for longer, it is recognised that nursing home care will continue to be an important part of the continuum of care into the future.
It is therefore important that all aspects of the nursing home sector are scrutinised over the coming years to ensure that service delivery and configuration meet the needs of service users in a sustainable and safe manner. It is also critical that investment in this infrastructure is maintained at a level that enables the appropriate standards to be met and that residential care capacity, both public and private, is increased in the coming years. The Government will engage with all sectoral stakeholders, as necessary, to ensure that this increase in capacity is delivered according to established demand and in the right locations.
In 2018, the Department of Health published the Health Service Capacity Review which forecasted future capacity requirements in acute care, primary care, and in social care (residential and homecare services) for the period to 2031. An update of the Health Service Capacity Review is now being planned. This programme of work will determine and review current capacity in the health system, both public and private, review drivers of future demand (including unmet demand and changing demographics) and estimate capacity requirements to 2040. This work will be underpinned by regional population-based planning and resource allocation models. In 2023, the HSE will also be finalising the future operational model for Community Based Public Residential Services. This model will include a blueprint for future service delivery across the full health service and will have the older person and their needs at its centre.
174. Deputy Cathal Crowe asked the Minister for Health if he will engage in talks with community pharmacies and their representative body (details supplied) on a restoration of the dispensing fee to a flat-rate model, a pay restoration in line with public sector pay agreements, and reimbursement for the ever-increasing administrative burden they face; and if he will make a statement on the matter. [29905/23]
View answer202. Deputy Michael McNamara asked the Minister for Health if he will meet with community pharmacists and their representatives in advance of the statutory deadline of 30 June contained in the Public Service Pay and Pensions Act 2017. [30045/23]
View answer205. Deputy Róisín Shortall asked the Minister for Health further to Parliamentary Question No. 1212 of 13 June 2023, when his Department will communicate with an organisation (details supplied); and if he will make a statement on the matter. [30049/23]
View answerI propose to take Questions Nos. 174, 202 and 205 together.
I recognise the significant role community pharmacists play in the delivery of patient care and acknowledge the potential for this role to be developed further in the context of healthcare service reform.
In that regard, various approaches to extending the scope of practice of community pharmacists are being progressed by my Department. The implementation of these necessitates engagement with a range of stakeholders and full consideration of all the relevant legislative and operational issues involved.
The regulations governing the pharmacy fee structure are set out in the Public Service Pay and Pensions Act 2017 (No. 34 of 2017) and in S.I. No. 639 of 2019, the Public Service Pay and Pensions Act 2017 (Payments to Community Pharmacy Contractors) Regulations 2019, which put the current fee structure in place, with effect from 1 January 2020.
Under Section 42(14) of the Public Service Pay and Pensions Act 2017 the current pharmacy fee structure must be reviewed every third year after 2020. My Department is currently carrying out a review and Department officials have arranged to meet with the Irish Pharmacy Union in that regard.
I believe that there is a real opportunity to work collaboratively with community pharmacists, and with other healthcare providers, to make a significant difference to patient outcomes. Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services, and provide better value for money.
175. Deputy Fergus O'Dowd asked the Minister for Health the number of nursing homes closed by court order under section 59 of the Health Act 2007 since January 2020; if he will list the name, address and operator of such homes; and if he will make a statement on the matter. [29906/23]
View answer176. Deputy Fergus O'Dowd asked the Minister for Health the number of nursing homes that received more than two inspections from HIQA in 2022 due to HIQA concerns about the care and welfare of residents; if he will provide details of these homes; if HIQA is now satisfied there are no current HIQA concerns about the care and welfare of residents in these homes; and if he will make a statement on the matter. [29910/23]
View answer178. Deputy Fergus O'Dowd asked the Minister for Health if HIQA has undertaken any prosecutions against any residential care facilities, proprietors, persons in charge and entities for any breach of regulations since April 2021; if so, the regulations breached by each such facility, person or entity; the details, including names of persons, facilities and entities prosecuted; the outcome of such prosecutions; and if he will make a statement on the matter. [29914/23]
View answer179. Deputy Fergus O'Dowd asked the Minister for Health if HIQA has undertaken any prosecutions since June 2021 against any residential care facilities, proprietors, persons in charge and entities for any breaches of regulations; if so, the regulations breached by each such facility, person or entity; the name of the persons, facilities and entities prosecuted; the outcome of such prosecutions; and if he will make a statement on the matter. [29919/23]
View answerI propose to take Questions Nos. 175, 176, 178 and 179 together.
The Health Information and Quality Authority's older people's services inspection team is legally responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland.
HIQA has advised my Department that two nursing homes were closed by court order under section 59 of the Health Act 2007 since January 2020.
• Donore Nursing Home, 13 Sidmonton Road, Bray, Co Wicklow. The Registered Provider was Brecon (Care) Limited.
• Oaklands Nursing Home, Derry, Listowel, Co Kerry. The Registered Provider was Bolden (Nursing) Limited.
HIQA has further advised that 23 Nursing homes received more than two inspections by inspectors of social services in 2022 however caution should be applied to interpreting this information in the context of risk in nursing homes for the following reasons:
• Increased frequency of inspection is sometimes but not always associated with concerns about the care and welfare of residents in a nursing home, it may also be for other reasons such as to inform a review of solicited or unsolicited inform received post routine inspections or to review the facilities and services being provided in a nursing home in order to inform decisions on applications to renew registration or vary conditions of registration.
• They may also reflect increased resources available to the Chief Inspector following the report of the expert panel including inspectors with expertise in fire safety and infection prevention and control who may carry out an inspection just to review these issues.
• Risk cannot always be viewed through the lens of a calendar year, for example a nursing home may have had three inspections in a 5 month period between the end of 2021 and the beginning of 2022 which would not equate to more than 2 inspections in 2022
Of the 21 nursing homes which are currently open and that were inspected more than twice in 2022 (two closed voluntarily in the last 12 months):
• The number of inspections was not aligned to concerns about the care and welfare of residents in 7 of the nursing homes.
• There are no outstanding concerns in relation to ten of the nursing homes.
• Four are on a trajectory towards improved compliance.
No prosecutions were taken against registered providers of designated centres for older persons since April 2021.
177. Deputy Bríd Smith asked the Minister for Health if he is aware of protesters currently outside Limerick maternity hospital that are causing distress to people going to medical appointments, workers, local residents and so on; if he will clarify when exactly the safe access zone legislation will be in place; if he will respond immediately to the urgent need expressed by people trying to access healthcare; and if he will make a statement on the matter. [29913/23]
View answerI am committed to ensuring that anyone seeking a termination of pregnancy can access services in safety and with privacy & dignity. To this end I secured cabinet approval to legislate for the designation of safe access zones around healthcare premises to safeguard access to termination of pregnancy services on the 27 July 2022.
Since that time, officials from my Department have worked with the Office of the Attorney General, and other relevant stakeholders, to draft the text of the bill. This legislation is currently being finalised and will be progressed through the Houses in the coming weeks.
180. Deputy Catherine Murphy asked the Minister for Health the number of WTE vacant consultant posts, by speciality, currently at St. James's Hospital; and when each of these vacancies will be filled, in tabular form. [29921/23]
View answerAs this is a service matter, I have asked the Health Service Executive to reply to the Deputy directly as soon as possible.
181. Deputy Catherine Murphy asked the Minister for Health when each of the regional infertility hubs will be opened; and the number of WTE staff, by job title, who will be working in each of the hubs, in tabular form. [29922/23]
View answerAs part of Phase One of implementing the Model of Care for Fertility we are establishing Regional Fertility Hubs within each of the maternity networks. Five of the six hubs are open and operational, with the sixth and final hub due to open in the coming months.
As the second part of the question is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
