Gross inequality and non-transparency in funding of nursing home care continues to be applied by the StateSunday October 3, 2021
€57 million/€12k per resident given to HSE nursing homes to offset reduced capacity while Value for Money Review remains concealed
3rd October 2021: Nursing Homes Ireland today expressed exasperation with the continued inequity and lack of transparency that is being applied by the State between the funding of private and public nursing home care. The Public Accounts Committee heard at a recent meeting, Thursday 23rdSeptember, €57 million in additional healthcare funding or €12k per resident was spent in 2020 within HSE nursing homes to offset income lost due to reduction in capacity. The €57 million was exclusive of the €356 million that was paid to HSE nursing homes under the Fair Deal budget. Also at the meeting, Committee members yet again questioned why a Value for Money Review for HSE nursing homes, which commenced in 2018 and was due for publication in 2019, has still not been published. This was despite the Committee stating in January it is “unacceptable” no timeline had been provided by the Department of Health for publication. And 19 months after they were last published, the HSE has still not honoured a commitment to the Comptroller and Auditor General that it would publish fees payable to its nursing homes under Fair Deal on an annual basis.
Tadhg Daly, NHI CEO states: “It is incredulous the State assumed some €57 million of health expenditure because occupancy within its nursing homes is reduced. No such equality was shown to private and voluntary homes. This equates to an additional payment of approximately €12,000 per resident over the course of the year. While the State engaged in this practice, 23 nursing homes closed their doors last year. This happened even though the regulator HIQA has warned for successive years that smaller nursing homes are proving no longer viable because Fair Deal fees are not commensurate with the reality of care costs. It needs to be explained why the State is applying two sets of standards: effectively topping up the funding for its nursing homes but letting others fail. It is an abuse of its dominance, exacerbated by a Fair Deal process that the Comptroller and Auditor General and the Department of Health know is devoid of an appropriate pricing mechanism to determine a fair price for care.”
At the PAC meeting, Committee Members again questioned why a Value for Money Review into HSE nursing homes, which was recommended in the Fair Deal review published by the Department of Health in 2015 and was finally undertaken in 2018, remains outstanding. The purpose of the review is to identify, quantify, and analyse the reason for any cost differential between public and private sectors and to make recommendations aimed at improving value for money. Mr Daly commented: “The State is engaged in a policy of procrastination when it comes to applying transparency with regard to the funding within its nursing homes. This important analysis was identified by the Department of Health within its review of Fair Deal in 2015. Here we are six years on and the Oireachtas Committee responsible for monitoring public expenditure is chasing its publication. Six years have passed and a piece of work identified by the State to achieve more efficient spend for public monies is concealed.”
Mr Daly has called on the HSE to deliver an element of transparency by publishing Fair Deal fees payable to its nursing homes. He states: “February 2020 is the last time the HSE published the fees payable to its nursing homes under Fair Deal. This told us HSE nursing homes were availing of fees that were a national average 62% above those payable to private and voluntary counterparts. But it is now evident the State enhances the funding to its nursing homes to the tune of tens of millions from health funding separate to the Fair Deal budget. The HSE provided a commitment to the Comptroller and Auditor General, within its examination of Fair Deal published in August 2020, that it would publish fees payable to its nursing homes annually. 19 months on, there is a requirement for the HSE to disclose the fees payable to its nursing homes under the publicly funded Fair Deal scheme. And it must ensure accuracy is applied, with the Comptroller and Auditor General finding fees that were previously published were €41 per week understated across 114 HSE nursing homes. Fees payable to private and voluntary nursing homes are published on a monthly basis.”
Spending incurred for Covid19 measures in HSE nursing homes should also be publicly presented, Mr Daly states. “Visibility is provided through the Temporary Assistance Payment Scheme with regard to the expenditure incurred within 400-plus private and voluntary nursing homes. Yet we have not heard what the spend was incurred for HSE nursing homes and the increased spend that was incurred should be presented to the public.”
Mr Daly concludes: “It is a source of deep frustration that there is no urge within the State to address fundamental failings with regard to how Fair Deal operates and how its budget is spent. The legacy of gross inequality and disparity in the funding of nursing home care continues. Approximately 22,000 people are supported by Fair Deal but there is a huge chasm in application of funding and transparency.”
Tadhg Daly is available for further comment. Interviews will be facilitated by Michael McGlynn, NHI Communications and Research Executive, who can be contacted at 087 9082970.
Note for Editor
The transcript for the Public Accounts Committee meeting can be accessed here: https://www.oireachtas.ie/en/debates/debate/committee_of_public_accounts/2021-09-23/3/