I am fully aware of the important role smaller and voluntary nursing homes play in their communities and I am conscious that they may not have access to the same economies of scale as larger homes or nursing home groups.
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.
It is important to note that this Government will continue to prioritise the best interests of nursing home residents to ensure that their welfare, care and well-being is ensured whilst simultaneously ensuring that nursing home care is accessible and affordable for everyone. It is vitally important that people are cared for in the most appropriate settings.
In 2019, the Nursing Homes Support Scheme funding (NHSS) budget was €985.8m. Year-on-year the budget has increased: in 2023 I secured a funding increase of €40 million for the NHSS, and for 2024 a further increase of €35.6 million. A further €10 million has been secured to assist nursing homes to comply with HIQA regulations.
Overall, €1.4 billion of the total Health Budget was allocated last year to support over 23,000 people under Fair Deal. This will increase to over €1.5 billion for 2024, and I am cognisant that the budget must support all residents under the Nursing Homes Support Scheme (NHSS) for the full calendar year. This funding is allowing an increase in rates by the National Treatment Purchase Fund (NTPF) of 5-6% on average per negotiation of Deeds.
It is recognised that the duration of contracts have shortened and that this increase in funding will go toward continuing to help nursing homes with inflationary costs in 2024.
The provision of free PPE and oxygen to private nursing homes continues, as of May 2023 this has cost approximately €77 million. A short-term extension to the Temporary Inflation Payment Scheme (TIPS), was also introduced last year to help with increased energy costs due to inflation.
In the weeks prior to Budget 2024 I held a roundtable discussion with private nursing home provider representative groups where the issue of continued support for the sector was on the agenda and I will continue to engage with them going forward.
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 of Health 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.
It is 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.
I also recognise that private and voluntary nursing homes also deliver very complex levels of care to residents in many cases.
It should also be noted that the Department of Health and I have regular interaction with the NTPF and have met them to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed.
The NTPF are the body designated, under Section 40 of the Nursing Homes Support Scheme Act 2009, to negotiate with persons carrying on the business of a nursing home, for the purposes of reaching an agreement on the maximum prices to be charged for nursing home care. There is no role for Ministers in the negotiation process which is conducted and agreed between individual nursing home providers and the NTPF.
There is no other mechanism for funding from the public purse for nursing home residents outside the Nursing Homes Support Scheme. It is imperative that private and voluntary providers continue to engage in the process as set out in the Nursing Homes Support Scheme Act 2009.
I met with Dr Cowley at the end of November, with Departmental officials, to discuss the current situation. I will continue to engage with Dr Cowley and intend to visit his facility in the near future.
