THE CHAIRMAN OF the Board of health watchdog Hiqa has admitted the boycott of the Fair Deal Scheme was mooted at a meeting he attended in 2015.
The Dáil’s Public Accounts Committee (PAC) is examining the potential anti-competitive conduct within the private nursing home sector following revelations about a meeting where some nursing home owners suggested collective action, including a possible boycott of the Fair Deal scheme, in protest at the fees they are being paid.
The Nursing Homes Support Scheme, also known as the Fair Deal Scheme, provides financial support for people who need long-term residential care. As part of the scheme, people make a contribution towards the cost of their care and the State pays the balance.
The records of the 2015 meeting were anonymously circulated to a number of TDs, and have since been forwarded to Competition and Consumer Protection Commission (CCPC), which is considering launching an investigation into anti-competitive conduct.
Confidential documents
The confidential correspondence included minutes of a meeting which the serving chairman of Hiqa, Brian McEnery, attended along with members of nursing home umbrella body Nursing Home Ireland and legal advisers.
Nursing Home Ireland rejected a call to appear before today’s meeting of the PAC.
Sinn Féin’s David Cullinane said at a previous meeting of the PAC that correspondence showed that legal teams present at this confidential nursing home meeting “warned people against some of what was being said – that what was being advocated potentially could be illegal”.
That is obviously alarming as well, and disturbing. All of this needs to be probed. Also there was a cover letter asking that this actual note of this meeting should be deleted and destroyed. Any time I see words such as ‘delete’ and ‘destroy’ makes me worried, as a member of this committee.
Appearing before the committee today, McEnery, the Hiqa chairman, said he attended the meeting in a professional capacity as an unpaid guest, and not as chair of Hiqa.
He outlined that he works for the BDO accountancy firm, is a leading expert in healthcare, and gives advice to nursing homes on financial matters, including the Fair Deal. He said he helps with the negotiations between nursing homes and the National Treatment Purchase Fund (NTPF). McEnery said he had worked with approximately 20 nursing homes in the last year.
He also sits as an non-executive board member of Nama.
He denied there was any conflict of interest between his role as chair of Hiqa and the other work he does, stating that he was appointed as chair through the Public Appointments Service (the independent jobs service which appoints people to public bodies).
He said that on his appointment he could not have made it clearer that he is a financial adviser to the health sector and senior care centres. ”I never tried to hide that fact,” he said.
Boycott of Fair Deal Scheme
Cullinane asked McEnery if the boycott of the Fair Deal Scheme was mooted at the meeting he attended on the 23 October 2015.
“I believe the word was used in the meeting,” he said.
Cullinane responded:
It was used and you are chair of the Hiqa and you stayed in that meeting.
“Yes,” McEnry said, adding: “I was not associated with that word, the comment or that sentiment.”
Cullinane said he was astounded that the Hiqa chairman would still stay in a meeting “when a boycott was put on the table”.
McEnry told the committee that he did not partake in any discussion about a boycott, and maintained that he was merely present at the meeting to answer the questions asked of him and to give his insights into the industry.
“I would be strongly opposed to that [any boycott]… I would have nothing to do with that,” he said.
Sinn Féin’s Mary Lou McDonald said it was in no way tolerable that the chair of Hiqa would be present at a meeting where the boycotting of the Fair Deal Scheme was raised. She said it was “outrageous” and said McEnry’s position, in her opinion, was now “untenable”.
Position untenable
Cullinane said McEnery should stand down from his position as of close of business today.
McDonald said there were rules in operation about nursing home not being allowed to operate as a collective as it could lead to price-fixing.
McEnery agreed there were good reasons for such rules. McDonald asked whether, in light of that fact, he was “worried” or “astounded” when such discussions arose within the course of the meeting.
“I would not have supported that as a proposition as that would not be the basis [on which] they should proceed,” he responded, reiterating that he did not get involved in the discussion.
Independent TD Catherine Connolly asked the Hiqa chairperson if, on reflection, he thought it was an appropriate meeting for him to attend because of the role with the health watchdog. McEnery reiterated he was not attending as the chairperson of Hiqa, but as a guest to give insights from his experience.
McEnery said he did contribute to the discussion on strategy or governance and left before the meeting ended. However, members of the committee said the minutes did not reflect that.
He said he had an issue with how the minutes of the meeting were documented.
The PAC Chairperson, Fianna Fáil’s Sean Fleming, asked if McEnery had any contemporaneous notes of the meeting, for which he replied he did not. Fleming his account of the 2015 meeting, which he detailed in his opening statement, showed he must have “an extraordinary detailed memory”.
Appears ‘grubby’
A number of members questioned how the Hiqa chairman could continue to hold his position, while also working to advise those in the nursing home industry.
Fianna Fáil’s Marc McSharry questioned him about potential conflicts of interest, insisting that public confidence in Hiqa should be paramount.
“You negotiate for one side and are the chair of the other side,” he said, adding that it appeared “grubby”.
“The gamekeeper is acting on the side of the poacher,” said McSharry, who asked McEnery if he believed he should step aside as chair to maintain the integrity of Hiqa.
McEnery said “there is a complete firewall” within Hiqa in terms of the regulation of nursing homes, insisting that it did not impact on him working and advising on financial issues relating to the industry.
“The proximity you have to so many other matters is what is concerning,” said McSharry, who said it creates the appearance that “the chairman is the gamekeeper and is advising the poachers”.
Nursing Homes Ireland
Earlier in the committee meeting, before officials from Hiqa arrived, Mary Lou McDonald strongly objected to the Public Accounts Committee going into private session.
Nursing Homes Ireland, the organisation that represents private nursing homes, had rejected a call to appear before the meeting today to answer questions about confidential correspondence sent to the PAC.
Fleming began today’s proceedings by reading out a letter from Nursing Homes Ireland chief executive Tadhg Daly who said he had been advised by the board not to attend today’s hearing.
Daly said in his letter that minutes of the 2015 meeting that appeared in public were confidential and that the organisation had not waived its legal privilege.
Fleming noted the committee’s objective was to protect the rights of the Irish public and hold institutions to account, but he said that citizens also had a right to legal privilege.
McDonald said she believed the committee’s aim to seek the truth and hold those who receive public monies to account on behalf of the Irish people was their paramount objective.
She then began outlining some of the contents contained in the minutes of the confidential meeting, and naming the people reported to be present.
Fleming cut her off and said those people were not present to defend themselves. He then said the committee would go into private session.
“I strongly object,” said McDonald, before the video feed was taken offline.
Social Democrats Catherine Murphy said it would be inappropriate not to follow up on the matter, observing that when something is reported in the national media the committee “can’t unsee it”.
Fleming instructed the committee not to refer to details specifically referenced in the minutes of the meeting, and the committee then went on to question McEnery about his own personal account of the meeting on 23 October 2015.
It was agreed to extend another invitation to Nursing Home Ireland to attend a future PAC meeting.
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