Committee of Public Accounts (PAC) finds lack of integrated financial and procurement management system in HSE is a ‘serious operational deficiency’

In its report published today on the Examination of C&AG Special Report 110 – Nursing Homes Support Scheme (Fair Deal), the Committee recommends that the planned implementation of such a system by the HSE is prioritised to ensure robust financial oversight can be undertaken and that the targeted timeline for delivery is adhered to.

The Comptroller and Auditor General published Special Report 110 - Nursing Homes Support Scheme (Fair Deal) in May 2020. That report was examined by the Committee in October 2020 with the C&AG and representatives from the Department of Health, the HSE and the National Treatment Purchase Fund.

Deputy Brian Stanley, Chairman of PAC, said: “Approximately 550 nursing homes fall under the Nursing Homes Support Scheme, known as Fair Deal – 80 per cent of which are operated by private or voluntary organisations and the remainder by the HSE. In 2018 Fair Deal supported some 23,300 individuals, at a cost of approximately €969 million. The Committee has made six recommendations arising from its examination of the Scheme.

“Currently, costs incurred under the Scheme are recorded within nine separate financial systems throughout the HSE. The Committee is of the opinion that the lack of an integrated financial and procurement management system is a serious operational deficiency and recommends that implementation of this system is prioritised to ensure robust financial oversight, and that the HSE provides PAC with annual progress updates.

“We have also recommended that the standard assessment of need for each resident in a nursing home is reviewed at appropriate intervals, as opposed to the current system where an assessment of needs is done before the person enters the care facility. This is to ensure that residents’ care needs are continuously met without imposing an additional financial burden in the event of their care needs increasing over time.”

PAC heard further concerns around charges to residents for medical supplies and services that should be provided free of charge to those with a medical card. The Committee has recommended that the HSE ensures that any resident of a nursing home in possession of a medical card has timely access to, and is never charged for, the medical equipment and services that they are entitled to under their medical card, irrespective of where they reside.

Deputy Stanley said: “In the case of charges for patients with medical cards, the Committee recommends that this matter is addressed urgently by the HSE and nursing homes to ensure that the practice of charging residents for items and services to which they are entitled as medical card holders can cease with immediate effect.”

Other areas where the Committee makes recommendations concern:

• Value for money review;
• Maximum pricing;
• Documentation of the National Treatment Purchase Fund’s negotiating procedures.

Deputy Stanley added: “In relation to the value for money review, the Committee would like the Department of Health to urgently provide a timeline for the publication of the Value for Money review of the Fair Deal scheme, which was originally due to be published in March 2019 but has yet to appear. We would also like to see a review of the 2009 Act which established the Fair Deal scheme, in particular the maximum pricing structure which governs negotiations between the NTPF and the private and voluntary nursing home sector.”

The PAC is a standing committee of Dáil Éireann which focuses on ensuring public services are run efficiently and achieve value for money.

The PAC Report Examination of C&AG Special Report 110 – Nursing Homes Support Scheme (Fair Deal) is available on the Oireachtas website.