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Nursing Homes vote no confidence in NTPF ahead of Annual Conference 2019

Thursday November 14, 2019

Private and voluntary nursing homes have overwhelmingly voted no confidence in the NTPF and the Fair Deal negotiation process. The actions of the NTPF and effectiveness of the Fair Deal scheme have come under national scrutiny arising from the current threatened closure of St Joseph’s, Shankill, due to the failure of the Fair Deal fee to meet the costs incurred to meet high dependency care needs of residents. Furthermore, the most recent HIQA Overview report for the nursing home sector, published in August 2019, stated for the second year running small nursing homes are closing their doors due to Fair Deal fees proving not sustainable for providers.

Minister for Health Simon Harris will deliver the opening address nursing home representatives from across the country at tomorrow’s annual conference at Citywest Hotel, Co Dublin.

On Tuesday 13th November, ahead of the conference, NHI undertook a snapshot survey of nursing home providers. 99 providers informed the survey that revealed there is an overwhelming lack of confidence in the NTPF in carrying out its responsibilities under Fair Deal and in the scheme itself. The organisation asked: “Do you believe the NTPF, during its negotiation process and in determining fees payable for provision of nursing home care, recognises the reality of costs being incurred to provide high-dependency, person-focussed, specialised care?” An overwhelming majority – 97% (96 of 99 providers) – replied “no”.

Furthermore, the providers were asked “Have you confidence in the NTPF Fair Deal Review Process?”. Nursing homes dissatisfied with the fee offered for the provision of care only have recourse to appeal the fee offered internally within the NTPF. Again, an overwhelming majority – 96% (94 of 99 providers) – replied “no”.

Tadhg Daly, Nursing Homes Ireland CEO, said the sector has lost confidence in the NTPF. He said: “The actions of the NTPF and the effectiveness of the Fair Deal scheme have come under scrutiny arising from the threatened closure of St Joseph’s, Shankill. Our survey informs specialist care providers across the country are stating Fair Deal is fundamentally flawed because of the failure by the NTPF to recognise the reality of costs incurred. It should spark huge concern when the independent regulator HIQA goes on record for two successive years to report nursing homes are closing their doors because the fees entailed are not commensurate with costs to provide the specialist care that nursing home residents require. Last week, through St Joseph’s, we were provided with a glaring insight into what is arising within our sector. 25 nursing homes have closed their doors since 2013. In 2015 the Department of Health was disturbingly informed in a report it commissioned fees payable under Fair Deal are not commensurate with costs entailed to ensure regulatory compliance*.

“Nursing homes are being put to the pin of their collar by the NTPF as a monopoly purchaser that offers a flat fee that is ignorant of the reality of costs incurred. Behind the sustained, unreasonable and coercive approach is a failure to appropriately fund the high-dependency, specialised care needs of nursing home residents.  The flat fees being offered are squeezing nursing homes to the extent that smaller providers are being forced to close their doors. Nursing homes in our rural communities in particular are under sustained threat and will have to close their doors like St Joseph’s if the NTPF doesn’t change its tune.”

The absence of independent appeals mechanism intensifies providers lack of faith in the Fair Deal process, as enforced by the survey. Mr Daly said: “Implausibly there is no independent recourse afforded to specialist healthcare providers should they fail to agree a fee with the NTPF. This represents a great injustice within our health services. As evident, from our survey and feedback derived, providers have no confidence in what is effectively a kangaroo court. At our conference we will be reiterating our call to the Minister for the establishment of an independent appeals mechanism and publication of the review of the Fair Deal pricing mechanism that is now over two years delayed.”


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

Notes for the Editor

*DKM Economic Consultants, Potential Measures to Encourage the Provision of Nursing Home and Community Nursing Unit Facilities (December 2015, commissioned by Department of Health). “In short, it is untenable that the State quality regulator can assess differentiated dependency levels and in doing so impose costs on nursing homes, while the State price regulator claims it is unable to reflect the same factor in its pricing decisions.”


Nursing Homes Ireland provided Members participating in the survey with opportunity to comment regarding the NTPF approach to the negotiating process and Fair Deal. Select comments by nursing home providers are now provided. The comments below are by separate providers.

  • They cannot back up their rate offers with any realistic recognition of costs to run a viable nursing home.  We had to go through the appeal process that last time and this was an extremely stressful process.  It’s not a negotiation process – it’s almost like who can tough it out the longest.
  • The NTPF argues that it is doing a good job of negotiating rates as only a few go through the appeals process. This is because there is little point in going through the appeals process when it is not independent. The outcome is never going to repay for any loss of income incurred whilst in the appeal as it will not be backdated.
  • No fair process. Doesn’t take into account day to day expectations that HIQA require and the upkeep that goes along with that. Doesn’t take into account the difference in standard between the private and public sector
  • They do not take in to consideration the cost of caring for highly dependent residents and the struggles nursing homes have to compete with the HSE for retention of staff.
  • We need more money to care for people with Dementia.
  • Fair Deal pay our service at a considerably lower rate than equivalent public facilities. No account is taken of the added costs associated with meeting the high dependency needs of the people we care for. HIQA demand facilities be of a certain standard which entails bank borrowings to provide and yet NTPF won’t acknowledge bank borrowings as an expense.
  • Fair Deal doesn’t take into account the very high dependency of residents that are requiring nursing home care and the cost that incurs
  • The NTPF do not want to listen or know about our struggles in running our care facilities with such limited funds. We are all running our nursing homes and complying with all HIQA standards and regulations, yet there is a huge differences in what public and private homes are paid weekly.
  • The NTPF rate should be based on actual care needs and care given based on the requirements of other inspectorates and stakeholders.
  • NTPF have absolutely no comprehension of the cost of care and the ever increasing costs. Accordingly the Fair Deal increases each year for the past 5 years have not even covered the known increased costs of our nursing home. I fear the nursing home industry is fast becoming a race to the bottom.
  • The NTPF are unwilling to accept the true running costs of the nursing homes and therefore continue to apply the fees which they determine are correct and ignore the operating costs.
  • NTPF seem to be more interested in keeping prices low rather than providing sufficient funds to cover proper care of Residents.
  • Have no regard for cost pressures.  Use the excuse of no money available.
  • Fees seem to be set according to the available budget and not negotiations held, regardless of the information submitted. The NTPF have rates they are willing to pay and that is the rate, that is paid, irrespective of care required.
  • The process does not take into account specialist dementia care and the criteria it uses for funding is not fit for purpose. We need to see the NTPF pricing structure report issued as a matter of urgency. We must have an equitable funding model regardless of whether you are residing in a public or private nursing home based on the needs of the people in our care.
  • Our NTPF representative did not negotiate. They had a figure in mind upon their arrival and there was no moving from that figure.  We gave the figure we were looking for and hoped for some form of negotiation but this did not happen. We were advised that if we did not accept the offer and wanted to appeal this would take months.  In the end we reluctantly accepted the offer.
  • It is very unfair to see the inconsistency of funding to nursing homes on a national basis and even on a local basis and HSE versus Private and Voluntary providers. Residents who choose to live with us should be entitled to access to the same level of funding. This would further facilitate our drive for better standards. It inhibits our ability to reward our hard working staff with better pay. This does lead to staff moving to other employers. I believe there needs to be a funding per dependency model.
  • The process for setting Fair Deal fee rates by the NTPF is not fit for purpose and will continue to contribute to the closure of nursing homes. There needs to be an  independent appeals system as part of the process.
  • NTPF Have no interest in setting a fair rate for care in line with HIQA standards. They exhaust the nursing home providers who have everything on the line into accepting unrealistic fees lest they be removed from the list of approved nursing homes.
  • They have zero interest in residents. We were told very clearly we should close down our specialist dementia unit if it wasn’t making commercial sense. “We’re in the business of buying beds”. Unprofessional and uncaring.
  • Arrive with a fee already decided on. Take no notice of information submitted or costs incurred or increased costs already identified, for example commercial rates.
  • An abuse of a monopoly power
  • It’s an unfair process where they speak constantly about the lack of funding and the county averages. The team do not listen to any providers point of view; they have no interest in the accounts at all. They pull a figure form the air and there is no right to appeal. It’s totally unprofessional, underfunded and unfair.
  • Not a commercial negotiation. Monopolistic purchaser. Trade abuse.
  • I believe they have a set figure they are willing to get away with spending, with no regard for the operating costs. Their remit is to spend as little as possible. They have no regard for our commitment to providing a high standard of care .
  • NTPF have only one agenda – keep cost to a minimum, yet expect same HIQA standard care for all residents despite huge differences in bed rate. This defies all logic and is certainly not a “Fair” Deal.
  • Totally underestimates the saving to the state by the provision of residential facilities by private and voluntary nursing homes. Increasing difficulty for the private sector to compete with public sector given the huge differential in fees between the two sectors.
  • We had a decrease in 2011 and have never been given that loss back.
  • NTPF seem oblivious to wage inflation and other costs
  • We have recently met with NTPF in determining our fee for 2020. Their negotiator had no interest in looking at the genuine costs we incurred in delivering care to older people. We presented the challenges in recruiting and retaining staff and the need to increase our pay rates to enable staff to afford rent in our area. NTPF negotiator stated they were not responsible for our home being located in an expensive area of the country. One of the criteria measured is costs incurred. As far as we are concerned this was not taken into account in the negotiation process.
  • We have engaged with the NTPF in recent years to explain in great detail the costs incurred and the challenges of providing the levels of care required by our residents.  We feel they as representatives are extremely constrained by the structure of the system which is outdated and not relevant.  Referring to county averages and previous rates is not reflective of the profile of residents.  We strongly feel that rates should reflect the resident need and be reflective of the level of service provided.  This would help differentiate and encourage providers to provide better care and to the most complex cases.
  • We as a private under 30 bed nursing home get under €850 per person. How is it possible that the HSE nursing home which is less than 5km away from us with fewer than 20 beds gets almost €800 more per person. How is this possible!
  • NTPF themselves advised us during our last expansion not to add on a dementia unit as they would not fund the additional staffing required or extra cost of fit out. We did it anyway and could do with it being double the size due to demand. They have no connection with the reality of what’s going on in nursing homes and in the community.
  • Abuse of Monopoly position while ignoring the realities of actual costs involved in providing care while complying with regulations and labour costs.
  • The NTPF does not take into account any of the reality of providing care in the regulatory framework. The regulator stipulates higher expenditure that the NTPF does not take into account. Yearly the thematic element of the HIQA inspection process can incur costs of approximately €20,0000 per annum – this is a conservative amount – along with the rising employee costs. An appropriate pay-rise for staff is not covered by the NTPF, along with now the requirement for employers to pay pension contributions for all staff which will be a further 2% on top of current wage bill. This is before mentioning the huge hike in business rates and general costs going up – the average NTPF increase equates to less than 1.2%.
  • They completely disregard rising costs and there is no fairness or transparency to the entire process.
  • They arrive with predetermined figure, no understanding of increasing cost base, ridiculous statements like why don’t you renegotiate with your bank.
  • They use the base rate that was being charged by nursing homes when the NTPF started. This is now totally out of date  due to requirements, cost of living etc . Our rate is still one of the lowest in the county but we have to provide the same standards of care .
  • The NTPF do not adequately fund nursing home care and there is an inequality regarding the private nursing home compared with the public nursing home, despite both providing high standards of care and services to the residents.
  • NTPF have preconceived rates beyond which they are unwilling to go.