'Inequality' in nursing home funding to come before public accounts committee

HSE chief Paul Reid, who is to address the Public Accounts Committee. Picture: Leon Farrell / Photocall Ireland

Ireland’s nursing home support scheme, known as the Fair Deal, is subject to a “huge chasm and inequality in funding” between private and public nursing homes, the Dáil’s Public Accounts Committee (PAC) has been told.

The PAC will hear  from Paul Reid, chief executive of the HSE, which administers the Fair Deal, and Colm O’Reardon, acting secretary general of the Department of Health, with regard to an audit of the scheme by the State’s accountant, the Comptroller and Auditor General.

That audit was laid before the Oireachtas last month, and contains a number of recommendations, all of which were agreed to, mostly regarding procedure and cost analysis and mostly actionable by the HSE.

However, in a submission to the PAC, Nursing Homes Ireland, the group representing 390 of Ireland’s 440 private nursing homes, said that the Fair Deal in its current form “acts to discriminate against residents in private and voluntary nursing home care”.

The Fair Deal was instigated in 2009 and sees those who avail of it contributing a percentage of their income and assets towards their own nursing home care, with the State paying the difference, with the aim of allowing care to be provided to all citizens regardless of means.

The scheme cost more than €1bn for the first time in 2019.

However, Nursing Homes Ireland alleges, in its submission to PAC, that expenditure within public HSE-administered nursing homes is “far removed from the reality of actual spend within such homes”, citing evidence from the C&AG which found that the HSE spent €270m in 2018 on those homes surplus to its Fair Deal budget allocation of €320m.

It states that “the HSE has proven to be evasive and non-transparent in presenting to the public the reality of HSE nursing home expenditure and costs”. NHI also claims that the National Treatment Purchase Fund, the body which negotiates pricing agreements with individual nursing homes, is “not fit for purpose” due to it paying “scant regard to being transparent in how it adjudicates fees”.

In his opening statement to the committee , Mr Reid is expected to “acknowledge that there is a variance in the average cost of care paid to public versus private nursing homes”.

However, he will state that variance is driven by factors such as the staff in public nursing homes generally receiving “higher staff pay rates and conditions”, the impractical nature of the older buildings used by HSE centres, and the fact the HSE provides nursing home services in locations “not viable for private providers”.

Meanwhile, the PAC yesterday heard that examining the management of public property assets by the Office of Public Works (OPW) will be a major focus of the committee’s time in the coming months.

The committee was responding to a submission from a member of the public, and former employee of the OPW, who stated that “there is little evidence of effective strategic estate planning” at the body.

“I do think it’s an issue for this committee, particularly with regard to the Hammond Lane site,” Green Party TD Neasa Hourigan told the committee.

The site in question refers to the proposed new family courts complex in Dublin, which had an initial new build cost of €40m, but which is now estimated at €141m.