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Fair Deal waits may lengthen to 20 weeks — Tony O’Brien

18 Feb 2015

Tony O’Brien, HSE

HSE DG Tony O’Brien has described the Nursing Home Support Scheme as the ‘Achilles heel’ of the hospital system, with lengthy waiting lists and insufficient resources, reports Gary Culliton.

The Nursing Home Support Scheme (NHSS, or Fair Deal) has become the “Achilles heel” of the hospital system, the Director General of the HSE has said.

Mr Tony O’Brien explained that there was a direct correlation between increased waiting times and longer queues for Fair Deal and the number of delayed discharges in hospitals and the numbers recorded waiting on hospital trolleys each day.

“Unless we solve that problem, we are going to be in for a very difficult 2015,” Tony O’Brien told the Joint Oireachtas Health Committee last week. “The HSE has funding in place only until the end of February, to sustain an 11-week waiting period for Fair Deal places. In the absence of additional resources, our concern is that by the end of the year, we will reach a waiting period of between 18 and 20 weeks.”

The projection was that 2,200 people would be waiting for Fair Deal nursing home places in December, the Director General said.

The NHSS is “perfectly set up” to be a demand-led scheme, the HSE believes. It faced significant demand, however — due to demographic pressures — and insufficient resources, O’Brien added.

As at November 29, there was a 15-week waiting NHSS period — beyond the process of financial assessment — to gain access to an available place. The number of people in the queue was 1,937. Due to a number of measures taken, by January 11 that wait had been brought down to 11 weeks — the number on the waiting list had reduced substantially to 1,188. By last week though, the trend was starting to reverse and the total was 1,234.

There were 1,196 approved applicants waiting for funding, with an average wait time of 11 weeks. This is a reduction of 939 people on the list, when compared to the 2,135 people on the list at the end of October, 2014. During the same period the wait time reduced from 15 weeks to 11 weeks.

A review of the Fair Deal is ongoing, and will include broad consideration of the services provided to older people and how they are integrated, and whether any changes are needed. This review will be completed this quarter.

In 2015, an additional €25 million is being provided to “augment the response to these challenges across the country and particularly in the Dublin Area, where the problem is most acute”.

An amount of €948.7 million has been allocated to the NHSS this year, which will fund an additional 300 places. As a result, a total of 22,361 people will be supported under the scheme during 2015.

Additional resources have been deployed since the first week in December 2014 to maximise effect in the current year. Some €10 million is being used to support an additional 300 long-stay care places under the NHSS, reducing the waiting time for funding under this national scheme to 11 weeks in the course of January and February 2015.

A figure of €8 million is being provided to increase access to short-stay beds across the Dublin and Louth areas, which will allow for transitional and rehabilitation services to be provided across a total of 115 additional beds targeting over 540 discharges from acute hospitals this year. The additional bed provision will include 65 beds that will come on stream on a phased basis from April through the commissioning of the former Mount Carmel Hospital as a dedicated community hospital for Dublin.

Additional packages
A figure of €5 million of the added funding will provide 400 additional Home Care Packages, benefiting 600 people in the course of the year. This will be focused particularly on the catchment areas of relevant acute hospitals, and on areas where existing home care capacity does not match the reliance that must be placed on home supports because of a lack of short stay beds, the HSE explained.

Furthermore, €2 million is being allocated to primary care to expand the community intervention team (CIT) services across Dublin, allowing for full coverage of this service across the city. The additional four teams will deal with 2,000 referrals per team per annum.

To apply for the scheme, individuals undertake a needs assessment and a financial assessment. Currently, the processing time to determine an application, following receipt of the assessments, was four weeks, which was in line with the average targeted time to process applications, the Minister for Health, Dr Leo Varadkar, said.

Funding under the scheme is budget capped, based on the allocation received each year. The HSE has statutory responsibility for the management of the scheme and must remain within the budget allocated.

In terms of demographics, the over-65s population is growing by approximately 20,000 each year, while the over-80s population, which puts the biggest pressure on health services, is growing by some 4 per cent annually.

In response to the growing challenge of providing services to an ageing population, and to address delayed discharges, an integrated care approach is being implemented “across the continuum of care inclusive of home, community, hospital and residential services”, Dr Varadkar told the Joint Oireachtas Health Committee.

Gary Culliton

Click here to view the full article which appeared in Irish Medical Times