Private firms are fighting to cut costs — and get their voices heard
Politicians must listen to major players if they want to end the ‘mixed-up economy’ in care, writes Mervyn Taylor
TO paraphrase WB Yeats, change “comes dropping slow”. The efforts of the Sunday Independent regarding nursing home fees are having an impact. Agencies are talking and Minister of State for Older People Jim Daly seems anxious to bring greater fairness to the system. Contracts that we had been told were perfectly adequate are now being reviewed.
There is talk of the Consumer and Competition Authority and Hiqa having a role. Meanwhile, the review of the statutory Nursing Home Support Scheme, the so-called Fair Deal, continues and a consultation period on the development of a statutory home care system will end soon.
Certain things seem clear after surveying the landscape in early autumn. The nursing home charges issue is not, as some are trying to portray it, a consumer issue. It is a symptom indicating a deeper malaise.
The vast majority of older people want to be supported to live in their own homes but despite the principles of person-centredness, integration and continuum of care we are now likely to have two separate statutory systems of care.
There is talk of the need for a ‘level playing field’ but that is not what the public want. They want a system that is clearly biased toward home care and provides good quality support and care in a congregated setting, such as a nursing home, only when it is really necessary.
What is also clear is that without any public debate, and without a single policy recommendation, nursing home care has effectively been outsourced to the private sector and public provision has become critically low.
Back in the days, we used to talk about a ‘mixed economy’. But when it comes to the provision of care it seems more like a ‘mixed-up economy’.
The State, through the National Treatment Purchase Fund (NTPF), deals with the public and private sectors differently.
Sage support and advocacy service has consistently pointed to the role of the NTPF as central to the nursing home charges issue.
The NTPF has to act within the terms of the relevant legislation, the Nursing Home Support Scheme Act (2009), and, in simple terms, it faces the dilemma of quantity over quality. It is the NTPF which determines the level of funding that homes get and it is the legislation and regulations which determine what nursing homes can and cannot get paid for. Essentially it is bed and board. HIQA, quite rightly, raises the issue of quality of life and a stimulating environment but that needs to be paid for… and so do incontinence pads.
That commercial companies seek to maximise profits is hardly news. That they should seek to maximise profits from the care of our brothers, sisters, parents and grandparents is surely pause for thought.
It is time for the Oireachtas Committee on Health to engage with this issue and, if it too is busy, why not have the new Petitions Committee cut its teeth on something that is of vital importance? Call in the NTPF, Hiqa, the Department of Health, the major commercial providers and tease out the issues.
They might even ask Sage which, as a support service for vulnerable adults and older people, had 46pc of its clients living in nursing homes in 2016.
Equally important, call in some of the nursing home providers who don’t see themselves as part of an ‘industry’ who often aren’t members of any lobby group and who genuinely struggle to provide quality of care while doing their level best to absorb as many costs as possible. They, too, are out there and their perspective needs to be heard.
Mervyn Taylor is manager of Sage. Sage will launch a discussion document on nursing home contracts in October
BALANCING ACT: Nursing home providers want to offer the best care possible but they are also in business to make money