Secret talks on Fair Deal boycott plan
Hiqa chief attended confidential meeting of nursing homes operators seeking to hike fees
THE chairperson of the independent health watchdog attended a confidential meeting of private nursing home operators at which a boycott of the Fair Deal scheme was mooted.
Brian McEnery attended the highly sensitive commercial meeting at a time when he was chair of the Heath Information and Quality Authority (Hiqa), the agency responsible for regulating private and public nursing homes.
The meeting was organised by the industry association, Nursing Homes Ireland, in October 2015, in response to members' frustration at the fees they are paid by the State under the Fair Deal scheme.
According to leaked records of the meeting, a refusal to admit new residents discharged from hospitals and controlling the number of new beds were also floated by operators as possible ways of "leveraging" a better price for their services.
However, lawyers present warned the meeting that any collective action such as a boycott risked an investigation by the Competition Authority and possible "dawn raids", the records show.
The NHI's board of directors later instructed that the records of the meeting be "deleted and destroyed", according to emails seen by the Sunday Independent.
Mr McEnery attended the meeting in his capacity as a partner in the accountancy firm, BDO, Hiqa said this weekend. In response to questions, it said that as the meeting had "nothing to do with Hiqa", Mr McEnery was not required to disclose his attendance. Asked about a potential conflict of interest, it said it had a "clear policy on conflict of interest" which is "adhered to at all times".
Mr McEnery specialises in the health sector and is a former advisor to NHI.
Other attendees included around 22 private nursing home operators and the chief executive of Nursing Homes Ireland, Tadhg Daly, along with senior partners with Eversheds, legal advisors to Nursing Homes Ireland.
The leaked records, seen by the Sunday Independent, provide a revealing insight into NHI's concerns over funding, and the actions some nursing home operators were prepared to consider to bring pressure to bear on the government to increase their fees.
Fair Deal fees for private nursing homes are set by the National Treatment Purchase Fund (NTPF) following negotiations with private operators. The fee per resident covers bed and board, and their care, but does not cover therapies and activities that they are required by law to provide. Private operators also complain that public homes are paid up to three times more per resident, and that the NTPF is not transparent or consistent in deciding the fees.
The records reflect these frustrations. One nursing home contributor suggested the idea that families could make a greater contribution, with a figure of 7.5pc to 10pc mentioned, but the money "would have to go directly to the nursing home and not to the State". Another said that nursing homes "should look to control the number of new beds under the scheme".
Another contributor noted that the threat of taking in new admissions from acute hospitals was a "powerful potential lobbying tool".
Other suggestions included using the National Treatment Purchase Fund's appeals process to "clog up the system" to bring the organisation to the table. Another attendee proposed boycotting new admissions and asked how far the NHI could go without being seen to be acting in an anti-competitive manner. Representatives of Eversheds explained that the NHI and its legal advisors "could not countenance" collective behaviour by members which would affect price on a collective strategy basis.
They referred to earlier legal advice given to Nursing Homes Ireland that "any widespread boycott could bring about a suspicion of anti-competitive behaviour and might lead to an investigation by the Competition Authority and dawn raids for individual operators".
The meeting concluded with three possible legal options for Nursing Homes Ireland. These included taking a judicial review of the different treatment between public and private nursing homes, which could "encourage" the NTPF and the Minister for Health to "engage in meaningful negotiations"; a complaint to the European Commission; and commercial negotiation while "avoiding any anti-competitive behaviour".
It is understood that none of those actions has been pursued by Nursing Homes Ireland. In a statement, Tadhg Daly, said members had expressed "considerable frustration with the fundamental failings" of Fair Deal since its inception. "Private and voluntary nursing homes are tasked with providing care for fees that are, on average nationally, half those payable to HSE counterparts.
"No independent recourse is available to private and voluntary nursing homes dissatisfied with the fee offered by the NTPF. Private and voluntary nursing homes have consistently advanced that the approach adopted by the NTPF is one of 'take-it-or-leave-it', with true costs of care not being reflected within the fee," he said.
The concern remains unaddressed by government, he said, and members remain "frustrated that the long-awaited review of Fair Deal remains outstanding".
"The healthcare provided must be fairly recognised through a fit-for-purpose pricing mechanism that recognises the true costs of the high-dependency, complex care they specialise in providing," he said.
"As a representative organisation, NHI works closely with our members to assist them on sector issues such as those outlined above, but we remain vigilant to ensure that our members seek recourse permitted by law."
Contacted by the Sunday Independent, Stephen McMahon, of Irish Patient Association, who has campaigned against extra charges in nursing homes, questioned the "perception of a closed trade association meeting, as reported, which allegedly was discussing additional charges to residents".