AnalysisPublic Affairs

Fair Deal scheme requires urgent reform

The Office of the Comptroller and Auditor General’s (C&AG) long-awaited examination of the Fair Deal scheme highlights that it requires urgent reform and is inherently unfair for private and voluntary nursing homes, Tadhg Daly, Nursing Homes Ireland (NHI) CEO writes.

The special report examining the scheme, which commenced in 2017, brings to light the long-standing poor practice and ineptitude of the National Treatment Purchase Fund Board (NTPF) in negotiating Fair Deal fees. NHI has called upon the Oireachtas to examine the report as a priority and discuss its findings with the C&AG.

Very serious questions arise from this examination regarding State utilisation of the 1 billion Fair Deal budget, with it presenting a 62 per cent differential in fees payable between State operated nursing homes and private counterparts. The examination finds between 2010 and 2018 the average weekly fee for public nursing homes increased by 26 per cent to 1,564 while the increase for private and voluntary over the same period was less than half, at 11 per cent, bringing them to 968.

The State is not subject to effective scrutiny and is hiking the fees payable to its nursing homes while residents in private nursing homes are inherently discriminated against. It is damning that the Comptroller and Auditor General has had to recommend the HSE “routinely” publish the fees payable for nursing home care within its individual nursing homes, with it pointing out no such fees were published in 2017. And the C&AG has found when fees are published for HSE homes, they are not accurate, with it finding in 2018 fees were on average 3 per cent higher than the published rates and an additional 23 million was required from the Exchequer to meet its budget deficits.

It finds one HSE nursing home’s weekly rate was hiked to 2,399 in 2017, 600 or 33 per cent higher than that applicable in 2016. Within another HSE home a reduction in costs did not result in a reduction in the HSE home’s cost of care. The absence of governance and oversight with regard to the HSE in its utilisation of Fair Deal is brought to bear through the examination.

The examination presents to the wider public the NTPF, the body tasked with negotiating fees under Fair Deal, is not fit for purpose. It finds no model is applied by the NTPF to inform how it can encompass dependency needs of residents in nursing homes. The Comptroller highlights the lack of transparency and criteria by which the NTPF ‘negotiates’ fees with nursing homes, pointing to lack of internal written procedures and those responsible for negotiating relying on “on the job training”. It is damning that 11 years post-introduction of the Fair Deal scheme, the Comptroller and Auditor General has had to recommend the NTPF develop guidelines and procedures for its staff in the conduct of its negotiations.

For many years, NHI has highlighted the gross inequality in the application of Fair Deal funding. This report confirms such and presents very serious questions with regard to the lack of transparency and openness from the State in the funding of nursing home care in its homes. The NTPF is subject to no appropriate scrutiny and oversight, with this report highlighting malpractice in how it goes about negotiating Fair Deal fees. No independent appeals mechanism applies for providers that fail to agree a fee with the NTPF, and this report highlights it has no applied formula or records to inform how it conducts itself. The examination must lead to fundamental change in the application of Fair Deal funding and immediate questions must be asked regarding the suitability of the NTPF. Covid-19 highlighted the underlying vulnerability of residents in nursing homes and people availing of nursing home care must all be treated equally, irrespective of the name over the door of the nursing home.

We welcome recommendation emanating from the examination that the cost components of long-term residential care require review to assess the reality of what nursing home care entails. We note the Department of Health has committed to engage with the HSE regarding such.

Covid-19 has brought important focus on the nursing home sector. Added to it, this report can provide a springboard for the State to implement a process that brings into effect fundamental reform to enhance Fair Deal’s appropriateness and effectiveness to meet the care needs of people requiring the specialised care provided by nursing homes.

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