Dáil Éireann Debate, Tuesday - 20 February 2024
588. Deputy Emer Higgins asked the Minister for Health for an update on the implementations on recommendations from the nursing homes support scheme (fair deal); and if he will make a statement on the matter. [7812/24]
Amharc ar fhreagraFair 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.
In 2015 a comprehensive review of the operation of the Nursing Homes Support Scheme was completed and subsequently published. The review can be found by following this link: www.gov.ie/en/publication/6f512a-review-of-the-nursing-homes-support-scheme-a-fair-deal/.
The Nursing Homes Support Scheme Review (2015) identified a number of recommendations for immediate implementation and a number of other complex issues that were deemed to require more detailed consideration. Emerging from this review, several subsequent reviews and actions incorporating different elements of the Nursing Homes Support Scheme have been completed.
In December 2021, the Department published the independently chaired Value for Money (VFM) review on nursing home costs. The review found that the cost differential between public and private/voluntary nursing homes is largely driven by variances in staff-to-resident ratios and the skill mix in public and private nursing homes.
The VFM Review made nine recommendations which the Department continues to take forward. The Value for Money Review can be found by following this link: www.gov.ie/en/publication/3859f-a-value-for-money-review-of-nursing-home-care-costs/.
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 negotiations and based on the NTPF’s cost criteria. These criteria include costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity.
The NTPF carry out this role independently under the 2009 Act. The NTPF has statutory independence, and there is no role for Ministers or the Department of Health in these negotiations.
The Department of Health published a review of the National Treatment Purchase Fund (NTPF) pricing system in June 2021 and continues to work on bringing forward the recommendations that emerged from this review. This review can be found by following this link: www.gov.ie/en/publication/41377-review-of-pricing-system-for-long-term-residential-care-facilities/.
A steering group has been established to oversee the delivery of the recommendations; this group has met on a regular basis since publication of the review. The group made four recommendations which are being progressed by the NTPF and the Department of Health.
• Recommendation 1: Formal assessment of using a formulaic approach in the pricing system as set out in Section 4 of the Report.
• Recommendation 2: Formal assessment of amending the approach to the assessment of “Local Market Price” to reflect prices within other nursing homes within a certain distance of the nursing home rather than within the same county.
• Recommendation 3: The NTPF to engage with nursing homes and their representatives in relation to enhancing the internal NTPF Review process.
• Recommendation 4: Amending the process for allowing for high dependency residents when the necessary systems are in place.
The delivery of recommendations 1-3 primarily sit with the NTPF. As per the recommendations of the review, the NTPF is reporting periodically to the steering group on progress in implementing the recommendations. It is recognised, however, that recommendation 4 has dependencies going well beyond the scope of the pricing review. This recommendation is therefore being addressed within the broader context of the reform of older persons' services, with appropriate links established between the pricing review steering group (including shared membership) to ensure that appropriate links are made between this recommendation and the others.
In addition to progressing the recommendations that emerged from the Pricing Review, important strands of reform to the nursing home sector are being, or have been, brought forward. The Government remains committed to delivering on the 86 recommendations of the COVID-19 Nursing Homes Expert Panel, especially those recommendations related to long-term sectoral reform,
Furthermore, addressing the shortage of care workers in Ireland is an urgent priority for the Government. To this end, the cross departmental Strategic Workforce Advisory Group was established in March 2022 to examine, and formulate recommendations to address, the challenges in front-line carer roles in the home support and long-term residential care sectors. The Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on 15 October 2022 and it contains 16 recommendations. The report can be viewed below:
www.gov.ie/en/publication/492bc-report-of-the-strategic-workforce-advisory-group-on-home-carers-and-nursing-home-health-care-assistants/.
Implementation of these recommendations is underway and is being overseen by a cross departmental Implementation Group, chaired by the Department of Health. The group meets quarterly and publishes progress reports thereafter. The last meeting was scheduled for 1 February 2024. The most recent progress report was published in October 2023 which can be viewed below:
www.gov.ie/pdf/?file=https://assets.gov.ie/275876/c0889fbf-3f9c-4235-9e79-e1240790fac7.pdf#page=null.
It should be noted that 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.
