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Dáil Éireann díospóireacht -
Thursday, 6 Apr 1995

Vol. 451 No. 7

Ceisteanna — Questions. Oral Answers. - Nursing Home Subventions.

Séamus Hughes

Ceist:

4 Mr. Hughes asked the Minister for Health if he will set out in tabular form the percentage of persons in receipt of subvention in each of the three dependency categories for each health board area; the reason the percentage of maximum dependency is so high in the Eastern Health Board, the Mid-Western Health Board, the North-Eastern Health Board, the North-Western Health Board and the South-Eastern Health Board areas as against the Western Health Board area; and his views on whether there is a need to ensure uniform and equitable assessments. [7198/95]

(Limerick East): The information which the Deputy is seeking is contained in the table I will circulate in the Official Report.

As the Deputy is aware, each applicant for nursing home subvention is subject to an assessment of dependency, means and circumstances. Article 7.1 of the subvention regulations obliges a health board to follow the procedures set out in the First Schedule to the regulations when assessing the dependency of a person who has applied for a nursing home subvention. The difference in the subvention rates reflects mainly the different levels of dependency of people applying for subventions. It may also reflect the extent to which health boards accommodate the most heavily dependent patients in their own hospitals and homes and the availability of health board long stay accommodation.

I might add that a working group comprised of officials of my Department and of the health boards is currently reviewing the operation of the Health (Nursing Homes) Act, 1990. The issue of the difference in dependency levels and subvention rates across the health boards is being examined in depth by the working group. I hope to receive the report of this group in the near future.

Health Board

Number and percentage of persons at 28.2.1995 in receipt of subvention of

Medium

High

Maximum

Eastern Health Board

277(13.1%)

357(20.6%)

1151(66.3%)

Midland Health Board

62(19.1%)

226(69.8%)

36(11.1%)

Mid-Western Health Board

216(27.7%)

280(35.9%)

283(36.3%)

North-Eastern Health Board

91(23.5%)

116(30%)

180(46.5%)

North-Western Health Board

131(32.5%)

124(30.8%)

1481(36.7%)

South-Eastern Health Board

116(28.9%)

125(31.1%)

160(40%)

Southern Health Board

156(31.1%)

188(37.5%)

157(31.3%)

Western Health Board

160(28.5%)

247(44%)

155(27.5%)

Total

1159(23.2%)

1563(31.3%)

2270(45.5%)

I am pleased to note the working group will report to the Minister in the near future. I raised this question as there is clear statistical evidence to indicate that only one in five people in the west are assessed at the maximum rate, entitling them to the highest rate of subvention, while 65 per cent of patients in the Eastern Health Board area obtain the maximum rate of subvention. The Minister will be aware of the standard uniform means of assessment throughout Ireland but there is no uniformity in the medical assessment criteria which is the root cause of this problem. I have here the medical assessment by the Eastern Health Board as against that of the Western Health Board. In the Eastern Health Board——

I am sorry to interrupt the Deputy but there is a long-standing convention that quotations are not in order at Question Time and I am sure the Deputy will abide by that.

Will the Minister agree there is a need for a uniform standard of national medical assessment and take it on board in consideration of the working group's recommendations?

(Limerick East): The working group is examining these matters. Certainly if one looks at the raw statistics one will find major differences in the percentages getting medium, high and maximum subventions across the different health boards, but the Western Health Board is not the lowest. The subventions are being examined to see whether there are statistical explanations for this and if there are variations in practice which are so wide that we need to take action to make them uniform. For example, if a health board has a practice of accommodating seriously dependent people in hospitals, they are not eligible for subventions because they are already within the hospital system. The Deputy will be aware that in the Eastern Health Board, particularly in Dublin, the fees charged by nursing homes are frequently double that of the rest of the country. While the maximum subvention, in terms of money, is significant, as a proportion of the cost it is not as significant as it would be elsewhere.

The Minister will realise that the contract between the private nursing homes and the patient is not the basis for my question. The reason for my question is there is clear statistical evidence to indicate that people in the west, particularly in the Western Health Board area, do not receive the same treatment, albeit at the discretion of the chief executive officer who is only implementing the rules. I urge the Minister to examine the grounds for medical assessment as there is a clear differentiation between the practices operating in the various health boards.

(Limerick East): As I said ealier, an expert group is examining this area. While there are variations in the new statistics it is too soon to conclude they are for the reasons suggested by the Deputy. While the Western Health Board is below the average for maximum subventions it is not the health board which has the lowest percentage of maximum subventions.

The incidence of high subventions in the medium category is well above the average in the Western Health Board.

That is the corollary of the situation.

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