The Minister for Health & Children, Mary Harney, T.D. notes the publication by the Ombudsman of a report of her investigation into the provision of in-patient services.
The Minister said “the Government’s commitment to the improvement of services for older people has been at the centre of health policy in recent years and will remain a priority into the future.”
“This commitment has been evident in both the level of investment in services, and the focus on the introduction of the Nursing Home Support Scheme (Fair Deal). The purpose of the Fair Deal Scheme is to equalise state support for nursing home residents and ensure that long term nursing home care is affordable for all who need it. Prior to the introduction of the new scheme, the State met approximately 90% of the cost of care in public facilities but only 40% of the cost of care in private facilities. Fair Deal does away with that historic anomaly.”
“Fair Deal ensures that those in need of long term nursing home care receive an equal level of state support whether they are in a public or private nursing home. The HSE has received almost 16,500 applications for the Fair Deal Scheme to date. Of these, over 12,000 have been approved and the applications continue to be processed on a daily basis.”
The Minister said it was against this background that she wanted to respond to the Ombudsman’s Report published today.
The Minister said the Ombudsman had furnished certain extracts from the draft report to her Department and, as requested by the Ombudsman, her Department had submitted representations in response. These representations set out the Minister’s views on the draft extracts supplied by the Ombudsman. They were considered and endorsed by the Government.
The essential argument made in the report is that the statutory duties imposed on the HSE/health boards under the 1970 Health Act in relation to in-patient services, including nursing home services, are not subject to any resource limitation; that adequate resources have never been provided to honour these obligations; that the State has, therefore, been failing for decades to meet its obligations fully and the Department and the HSE/health boards have tried to hide this “failure” and have acted in a less than transparent and accountable way.
The Government is not aware of any country in the world where health and personal social services are provided without some form of prioritisation which reflects the reality of resource limitations. It is not credible to suggest that the Oireachtas, when it enacted the 1970 Act, intended and expected all services to be provided immediately once a clinical/social need for them had been established. The reality is that access to health services has always been determined by a combination of clinical and other professional judgements within an overall resource availability envelope.
Far from being a hidden feature of health services, the gap between capacity and need has been a topic of public and political debate over the decades. More recently, the annual national service plans produced by the HSE and laid before the Oireachtas have described in an open and transparent way the quantum of services that it is planned to deliver each year within the resources made available to the HSE.
Over the years, successive Governments have sought to improve access to services through a combination of providing extra resources and seeking to achieve more within existing resources. There is ample evidence of improvements in health outcomes and in access to services but the Government would be the first to acknowledge that more needs to be done.
The Government strongly refutes the allegation by the Ombudsman in the report that the Minister or her Department failed to co-operate with this investigation. The Department made it clear from the outset of the investigation, having consulted as normal with the Office of the Attorney General, that it could not accept that a number of areas of the proposed investigation came within the ambit of the 1980 Ombudsman’s Act.
In fact, the 2001 Ombudsman’s report on Nursing Home Subventions acknowledged that “the Ombudsman’s jurisdiction relates to administrative actions only and does not encompass all of the elements which make up the wider governmental process”. Similarly, the Ombudsman’s remit does not cover the conduct of litigation by the State.
As is clear from the representations made to the Ombudsman and published today, the Minister has fundamental concerns about the way this investigation was undertaken and the failure to follow fair procedures, as well as the content, scope and language of the report. These issues will be considered carefully now that the final report has been published.
Representations to Ombudsman 20 Aug 2010
Representations to Ombudsman 23 Aug 2010
Representations 23 Aug 2010 – List of Appendices
Representations 23 Aug 2010 – Appendix II (list of correspondence)
Representations 23 Aug 2010 – Appendix II (correspondence)
Representations 23 Aug 2010 – Appendix III
Representations 23 Aug 2010 – Appendix IV
Representations 23 Aug 2010 – Appendix V
Representations 23 Aug 2010 – Appendix VI
Representations 23 Aug 2010 – Appendix VII
Representations 23 Aug 2010 – Appendix VIII
Representations 23 Aug 2010 – Appendix IX
Representations to Ombudsman 29 Sep 2010
Representations to Ombudsman 22 Oct 2010