Office of the Comptroller and Auditor General

Special Report Series Number 3


The Comptroller and Auditor General, Mr. John Purcell, has today published his special report on the payment of arrears of Nursing Home Subventions by Health Boards.


The entitlement of a person to a Nursing Home Subvention depends on their level of dependency and on an assessment of their means.

In calculating a person?s means, regulations made in 1993 provided that Health Boards should disregard a sum of money equal to one-fifth of the Non-Contributory Old Age Pension. This money was to be retained by the person for personal use.

Different interpretations of the regulations emerged between the Health Boards while legal advice received by the Department of Health and Children at the end of 1996 showed an incorrect interpretation of the regulations by six of the eight Health Boards. The effect of the incorrect interpretation was to reduce the amount of subvention towards the cost of maintaining eligible persons in Nursing Homes.

In 1998, the Department provided an additional ?4m to the six Health Boards to enable them to eliminate the arrears and provide other services to the elderly.

Earlier this year the Ombudsman issued a report on his investigation into Nursing Home Subventions which established, among other things, that most Health Boards had not been applying the rules regarding means properly and had been slow to pay arrears to those who had been underpaid as a result of the misinterpretation. In his report the Ombudsman stated that

"Untangling the detail of what precisely happened the additional allocation would involve a separate investigation".

Consequently, the Comptroller and Auditor General, as statutory auditor of the Health Boards, instigated a special audit to determine the extent to which the Health Boards in question had met their obligation to pay arrears of subvention to the affected persons from funds provided for that purpose by the Department of Health and Children.

Main Findings

? Six Health Boards ? the Midland, Mid-Western, North-Western, Southern, South-Eastern and Western ? were slow in paying the arrears

? Even though the money was provided in 1998, four of the six Health Boards did not start paying out arrears until 2000

? The total amount of arrears payable was ?2.2 million but by June 2001 just over half of this amount had been paid out

? Funds provided for the payment of arrears were diverted to other services within the six Health Boards

? Apart from the subvention, there is inconsistency in the awarding of discretionary top-up payments to Nursing Home patients. This could have negative financial implications for the State unless it is addressed urgently.

Mr Purcell stated today

"The initial failure on the part of the six Health Boards to correctly apply the means provisions of the Nursing Homes regulations was compounded by the inordinate delay in paying arrears to those who had been disadvantaged by the misinterpretation. It is incumbent on public bodies, such as Health Boards, to have procedures in place to ensure that those who are deprived of their entitlements because of administrative error have the matter remedied within a reasonable period. All six Health Boards have questions to answer in this regard".

Note for Editors

The Comptroller and Auditor General is an independent constitutional officer with responsibility for the audit of public funds. He reports to Dáil ?reann. He is supported in the discharge of his function by a staff of 120.

The full text of the report is available on the website of the Office of the Comptroller and Auditor General (go to )

For further information about the report, please contact:

Jennifer O'Halloran