Hand holding mobile phone with Nursing Homes Ireland news on it

Fair Deal budget creaks yet public nursing homes remain unaccountable

Friday April 19, 2019

New HSE DG must implement a policy of transparency

Nursing Homes Ireland today called on the HSE to publish with immediate effect fees payable to its nursing homes under the Nursing Homes Support Scheme (Fair Deal). NHI said incoming HSE DG Paul Reid needs to urgently bring accountability and transparency to bear with regard to spend in public nursing homes when he starts next month. NHI has accused the HSE of “being a law unto themselves” in failing to deliver transparency re public nursing home spend.


Tadhg Daly, NHI CEO states: “Reports this week inform Fair Deal is under severe financial pressure and extra resourcing may be required to supplement the €1 billion budget. There is real concern older people will be forced to wait extended periods for their funding to be released. A report this week informed almost 400 older people in our hospitals ready for discharge are awaiting nursing home care. The financial pressures provide further impetus for transparency to be introduced with regard to what the cost of care in HSE nursing homes entails.


It is now over a year since the HSE last published fees payable under Fair Deal for residents supported in HSE nursing homes. They were last published in March 2018, informing HSE nursing homes were being paid fees under the scheme that were a national average 60% above those payable to private and voluntary counterparts. HSE fees have been published three times the past eight years.


HSE nursing homes provide care to one in five residents supported by Fair Deal yet account for one-third of the annual budget spend. Yet they go extended periods not disclosing the fees payable under Fair Deal. By contrast, fees payable to private and voluntary nursing homes are published on a monthly basis. Here we are in 2019 and a State agency is hiding fees payable to itself for the provision of care to thousands of older people. While this is occurring we’re informed the budget is creaking. It’s high time spend in nursing home became subject to scrutiny and accountability. One of the most pressing priorities for new DG Paul Reid must be to implement accountability and transparency surrounding public nursing home spend. The Fair Deal budget accounts for a very significant spend within our health services. We cannot continue to turn a blind eye to how HSE nursing homes are utilising the budget.


It’s high time for the HSE to stop being a law unto themselves and to start becoming transparent with regard to public nursing home costs. It’s actually ignoring the Department of Health in not publishing the fees payable to it under the Fair Deal scheme. The Department ‘s review of the scheme, published in 2015, recommended the HSE publish the fees payable to it on an annual basis. Since the review has been published, the HSE has ignored such requirement and prolonged delays in publication of their fees have continued.


Mr Daly said the Department of Health-commissioned Value for Money Review, being undertaken to examine expenditure within public nursing homes, remains outstanding. This is despite the Public Accounts Committee calling in December 2018 for it to be completed by March 2019.  He said: “The long-standing lack of transparency is an insult to the public. We’ve a right to know what is the reality of expenditure within HSE operated nursing homes.”


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


Notes for the Editor

  • The last published fees payable to HSE nursing homes under Fair Deal were for the period February 2018 and were published March 2018.
  • Analysis informed HSE nursing homes were being paid fees that were a national average 60% above those payable to private and voluntary nursing homes
  • In County Westmeath, HSE nursing homes were being paid fees that were 163% above those payable to the private and voluntary nursing homes in the county. Within every county, HSE nursing homes were paid fees that were significantly above those payable to private and voluntary homes. The ‘lowest’ differential was in Co Dublin, where the average fees payable to HSE were 40% above those payable to private and voluntary.
  • The February 2018 fees informed in the 16-month period from when they were previously published the fees payable to HSE nursing homes increased by an average 11%. Over the corresponding period, the average fees in private and voluntary nursing homes had increased by 3.9%.