Nursing Homes Ireland calls on Minister for Health to investigate NTPF


NTPF must be called to account: Abdication of responsibility & protracted delays in review of Fair Deal pricing mechanism unacceptable

Nursing Homes Ireland (NHI) has today, 15th November, called on the Minister for Health to undertake an independent examination of the operation of the National Treatment Purchase Fund. NHI has accused the NTPF of deliberate procrastination, acting beyond reproach and abdicating the responsibilities placed upon it by the State with regard to the Review of System for Setting Nursing Home Prices under the Nursing Home Support Scheme. 

Speaking ahead of the Nursing Homes Ireland Annual Conference 2018, Tadhg Daly, NHI CEO said: “The actions of the NTPF with regard to the review of the Fair Deal pricing mechanism are unacceptable, a disgrace and typify what is happening at the Fund - procrastination, procrastination, procrastination.  The Department of Health’s review of the Fair Deal scheme, published in July 2015, initially recommended that the review happen within 18 months (January 2017). 

“Minister for Health Leo Varadkar then commissioned a review of the pricing mechanism in 2016. A specific term of reference stipulated the timeframe for completion be 1st June 2017 but Minister Varadkar had it stipulated within the terms the NTPF push to complete it quicker. Seventeen months past that deadline, the pricing review remains outstanding. The Taoiseach, as well as the Minister for Health, must seek answers regarding this organisation’s dereliction of its responsibilities.

“Who is the NTPF answerable to? It has monumentally failed in its duty to fulfil the obligation placed upon it by the State to review the pricing mechanism for nursing home care. Who holds it accountable? All the while, a pricing mechanism continues to operate that applies gross and unprecedented inequality in utilisation of public expenditure. Newly published research undertaken by NHI confirms that in 2017 the average financial contribution per resident within a HSE nursing home was circa €68,812 by comparison with €35,114 per resident in private and voluntary nursing homes.  At our Annual Conference today we will be urging the Health Minister to commission an independent examination of a body that appears to abdicate responsibility and act with impunity. He must seek real answers as to why the NTPF continues to stall this review that is fundamental to the provision of specialist, round-the-clock care within our communities.”

Entering Winter season, Mr Daly will present the critical importance of focussed engagement all year round between acute hospitals and nursing homes to facilitate timely discharges back into the community. The NHI analysis presents circa 114,000 bed days were lost within our acute hospitals last year arising from delays in accessing long-term nursing care.  

Mr Daly said: “There needs to be early and ongoing engagement between those responsible for discharges within our acute hospitals and nursing homes to facilitate timely transfers back into the community. Member nursing homes report engagement can be haphazard and disjointed. Today we will be urging the Minister, the Department and the ED taskforce to begin engagement with the NHI to ensure timely discharge of patients during the Winter period and all year round. We must focus upon ensuring the hundreds of people awaiting discharge to long-term nursing care are supported to avail of it without delay, wherever possible. This particularly pertinent given 60% of people awaiting discharge from our acute hospitals are awaiting such care.”

Published to coincide with the Annual Conference, the NHI analysis also highlights:

  • Private and voluntary providers are being tasked with providing care for fees that are an average 65% below those payable to private and voluntary homes.     
  • Over the 18-month period start of year 2017 to end of June there has been a 329 person reduction in the number of people being funded by the scheme. The reduction in people being funded in private and voluntary nursing homes has been 286.
  • There has been a significant escalation in the number of people leaving Fair Deal. 964 more people left in the year 2017 by comparison with 2013.
  • Juxtaposed with this, fewer people are entering the scheme. In 2017, 48 fewer people entered by comparison with 2016. 177 fewer entered in 2017 by contrast with year 2013.
  • The figures point to an significant trend of people presenting for nursing home care with increasingly high-dependency, high-acuity, complex care needs, with average lengths of stay approximately 1.9 years compared to 4 years previously.
  • 78.5% of new entrants to Fair Deal entered private nursing homes in the year 2015 to 2017. 21.5% entered a HSE nursing home. Private and voluntary nursing homes are majority providers of the high-dependency, high-acuity, complex care needs being presented by persons availing of Fair Deal


Download a copy of the report here.


Tadhg Daly, NHI CEO, is available for further interview. Contact Michael McGlynn, NHI Communications & Research Executive at 01 4699806 or 087 9082970.


Notes for the Editor


Extract from Department of Health Review of the Nursing Homes Support Scheme, A Fair Deal, published July 2015.

“Within 18 months, the NTPF should review the present system and submit future pricing proposals to the Minister for Health with a view to:-

i) Ensuring that there is adequate residential capacity for those residents who require

higher level or more complex care;

ii) Ensuring value and economy, with the lowest possible administrative cost for the State

and administrative burden for providers;

iii) Increasing the transparency of the pricing mechanism so that existing and potential

investors can make as informed decisions as possible


Delays in publishing the review

  • Extract from Public Accounts Committee Meeting, 14th June 2018 (Financial Statements 2016: National Treatment Purchase Fund).  Deputy Marc MacSharry: “When does the review go to the Department?” Chairman, NTPF: “One bit of it will be happening very soon, within the next number of weeks. That is the bit where Deloitte and Prospectus will provide the NTPF with an input to assist us in deciding what proposals we should put to the Departments of Health and Public Expenditure and Reform. We will bring proposals to the tripartite steering group involving the NTPF and the two aforementioned Departments on the pricing mechanism element. We are not looking at the total budget or anything like that. I expect that we will be bringing proposals forward in a matter of weeks.
  • Reply to Deputy John Brassil, Questions in Dáil Éireann, 24th May 2018. Minister Jim Daly: “The most recent update from the NTPF is that the report will be finalised by mid 2018.”  
  • Reply provided to Senator Colm Burke by Department of Health for Oireachtas Health Committee Meeting 7th February 2018. Department of Health: “A Steering Committee has been established to oversee the review of the pricing system for private long-term residential facilities. This Steering Committee is chaired by the NTPF and includes representatives from the Department of Health, the Department of Public Expenditure and Reform, and the NTPF, work in this area is ongoing and well advanced. The NTPF have responsibility to the development of this report. The most recent update from the NTPF is that the report will be finalised and ready for my review in the first half of 2018.”  
  • In response to representations by Deputy Mary Butler, 11th April 2017, then Minister for Older People Helen McEntee said: “A Steering Committee has been established to oversee the review of the pricing system for long-term residential care facilities. This Steering Committee is chaired by the NTPF and includes representatives from the Department of Health, the Department of Public Expenditure and Reform, and the NTPF, and work in this area is well advanced.”
  • Terms of Reference for Review of System for setting nursing home prices under the Nursing Home Support Scheme (July 2016): “5. The timeframe for completion of this Review is scheduled to be June 1st 2017 but the Minister has asked that NTPF consider whether it can be completed more quickly than that.”






Find a nursing home in your area...