The Government could help local communities take control of publicly-run nursing homes which are under threat of closure, Minister for Health James Reilly has said.
The Government wanted to protect community nursing units and would "think outside the box" and look at different combinations of arrangements to support them.
Dr Reilly has said previously that community nursing home beds will close next year. He has warned that units with fewer than 50 beds are particularly vulnerable, although the quality of care in such centres is excellent.
He told The Irish Times that where community nursing homes were not financially viable and local people wished to retain them or take them over, he would be happy to look at how they could remain in operation.
He said different combinations of measures could be examined. He said communities might fundraise to address any infrastructural problems and, in parallel, the Department of Health or Health Service Executive could invest money to extend the number of beds on the site to make them viable. He said another option might be for a local community to take over the community nursing unit from the HSE and establish a legal trust to operate it. He said the State could then allocate money from the Fair Deal nursing home scheme budget per bed in the unit.
Existing community nursing units are facing difficulties as a result of HSE budgetary problems, the moratorium on recruitment and a requirement to invest in infrastructure to allow them to meet new standards.
Last week, The Irish Times revealed that, in its draft service plan for next year, the HSE had been looking at closing between 555 and 900 community nursing home beds. This could involve up to 10 homes closing. The Minister has not yet approved the HSE's service plan.
Separately, the Minister said he wanted private health insurance companies such as the VHI to put in place "serious discounts" on fees paid for procedures carried out by consultants in hospitals which could be performed at primary care level.
He said he would be asking the VHI to draw up a schedule of procedures that could be carried out either by consultants or GPs in primary care. Dr Reilly suggested these could include sebaceous cysts, biopsies for skin cancer and the removal of lesions that appear suspicious.
He said it was "absolutely and utterly nonsensical" that insurance companies were paying a "side room fee" to a hospital for a procedure that could be carried out by a GP.
Dr Reilly confirmed the Government would press ahead with controversial plans to remove existing arrangements which designate particular beds in public hospitals for private patients. He said the legislation was complex but should be introduced by the middle of this year. The new legislation will allow hospitals to charge for all private patients treated, a move insurance companies have said will add hundreds of millions to their costs and force up prices by as much as 50 per cent.
Dr Reilly again said he wanted to see costs tackled aggressively by insurance firms. He said the Government wanted to move away from charging companies for every night a subscriber was in a public hospital to introduce a new charging system based on the procedure carried out.
The Minister also confirmed he was to express concern to the board of the State-owned VHI when he called them in the new year over the company dropping cover for procedures aimed primarily at older patients from its more popular plans.
He pointed to the VHI removing cover for hip replacements from its Plan B, which he said was the most popular with people over 50. "I believe they are trying to segment the market and it is undermining community rating and I am not happy about that." Dr Reilly said the VHI's move was aimed at "directly trying to manipulate the market".
