Dáil Éireann Debate, Wednesday - 16 May 2012
1Deputy Billy Kelleher asked the Minister for Health the terms of reference of the fair deal review; if this review will take into account broader issues regarding the State’s care for the elderly; the person who will be carrying out this review; if it will be a private company; and if he will make a statement on the matter. [24407/12]
Amharc ar fhreagraThe nursing homes support scheme was introduced in October 2009 with a commitment to review its operation after three years. The reason for allowing this period to elapse was to ensure trends and statistics would be available to inform the work. The review of the scheme will look at, among other issues, the ongoing sustainability of the scheme, the relative cost of public versus private provision, the effectiveness of current methods of negotiating price in private nursing homes and setting price in public nursing homes, and the balance of funding between residential and community care.
The terms of reference for the review are being finalised at present. The Department of Health will seek tenders through the public procurement process for the carrying out of the review. This process will take approximately four months. It is also intended to carry out a public consultation over the summer to inform the review. It is anticipated the review itself will take approximately three months to complete. It is expected the review will commence in the last quarter of this year and be completed in early 2013.
In the context of the fair deal scheme, most people accept it has brought certainty in terms of funding for relatives in nursing homes. It is clear, however, that the longer the review goes on, the more it undermines confidence and certainty in the scheme in terms of ensuring that funding will be in place when people need nursing home supports. I am amazed that in advance of the review up to 1,000 community nursing home beds will be taken out of the system. Some have already been taken out and 100 per month will be lost per month up to the end of October. While the nursing homes scheme has been a success in terms of bringing certainty to the funding, equally, the decision of the Government to reduce the number of nursing home beds in advance of the review being finished and adjudicated upon seems to indicate the cart is well before the horse in this case.
The terms of reference are critical. Public versus private care is an issue. I frequently look back over the transcripts of the Dáil to find out the thinking of the Government when in opposition. It is clear there was much concern at the reduction in the number of public nursing home beds but that seems to have changed completely in the past 12 to 14 months in terms of commitment to funding community nursing home beds.
Could the Deputy ask a question please?
Does the Minister of State not accept that the longer the review goes on - we might have to wait ten or 12 months before the review is finalised and acted upon - the more uncertainty is created? Equally, does she not agree that grave concerns were propagated previously about property and the 5% per year up to a maximum of 15% over three years? The Minister of State has opened up that debate again. What is her thinking behind the reliance on the property aspect of the home for funding the scheme?
There is no uncertainty about the scheme. We could not have made it clearer. The funding is available. It is ring-fenced and will be available in the future. No one who is in need of long-stay nursing home care for older persons will be in any doubt about that.
While I accept that beds are closing, equally, many beds are opening. I refer to Ballincollig, for instance, which the Deputy knows very well, and to other areas of the country where we are opening other beds. It is not the case that we are depleting bed numbers. We are opening a different type of centre and offering a different type of care.
On whether the scheme is sustainable in terms of property values, that is irrelevant at this stage. The review will deal with that. I will not pre-empt what the review will come up with. I am sure the Deputy will appreciate that. Equally, it must be said loud and clear that only 17% of the people who have applied for the nursing home subvention or loan scheme are relying on the sale of property after death. Everyone else is paying upfront. That must be part and parcel of the review.
That reinforces the view that there was a great deal of scaremongering when the scheme was being established in 2009 in terms of the number of people who would be forced to sell their homes to fund the scheme. There is no getting away from the fact there will be fewer beds in the system. There is no doubt about that. The number of beds is being reduced continually and the figures exist to prove it. Not only is the fair deal nursing home scheme going to come under additional pressure because of the reduction in bed numbers but also it will have a knock-on effect on acute hospitals and moving people from the acute setting into community nursing homes. Could the Minister of State provide an assurance, while we await the review, that funding will be available for everyone who applies under the nursing home support scheme? When the review is completed, it will probably be published in January or February 2013. Can the Minister of State indicate whether funding will be available in December, for example, for next year because we need certainty in that regard?
What is certain is that not everyone who applies will receive funding because not everyone who applies is in need of long-term care. From the information available in the reviews completed, it is clear that approximately 40% of people in nursing homes should not be there in the first place. We must seriously examine the situation.
The Minister of State at the Department of the Environment, Community and Local Government with responsibility for planning and housing, Deputy Jan O'Sullivan, and I have been examining other forms of assisted living with all the voluntary groups. We are committed to ensuring funding will be provided for anyone who needs - as opposed to applies for - long-term care. There will be sufficient beds within the system. There are particular areas where we must ensure we act where the Health Information and Quality Authority, HIQA, is involved and has decided the accommodation is not appropriate. I am sure the Deputy would agree with that. HIQA was established by the previous Administration and is one of its most useful initiatives.
