Mr. Paul Reid:

I thank the Chairman and members for the invitation to meet the Special Committee on Covid-19 Response. I am joined by my colleagues, Dr. Colm Henry, chief clinical officer, and Mr. David Walsh, national director, community operations.

I express again my condolences to the families and relatives of those deceased as a result of Covid-19, in particular those who were residents of nursing homes. We have seen the impact of Covid-19 was greatest in such settings. The experience of the outbreak across these facilities and the immediate responses put in place by the HSE to support these services across public, private and voluntary settings were unprecedented.

I have submitted a detailed paper to the committee which captures the substantive ongoing level of engagement across the system between the HSE, HIQA, the Department of Health, as well as the private and voluntary nursing home representative group, Nursing Homes Ireland, NHI. In the paper, I have set out the different mandates of the HSE and HIQA in this sector. However, we are united in the singular mandate of safeguarding the health and well-being of older persons living in long-term residential care. A significant feature of the response to this pandemic has been the extent of the co-operation between HIQA, as the regulator, and the HSE. The knowledge of the sector, acquired by HIQA over many years through its inspectorate, has been used on an ongoing basis to inform the actions and supports provided by the HSE.

The HSE area crisis management teams, which were formed with a specific purpose of implementing the Covid response in turn set up Covid response teams. These enable the management of outbreaks of this insidious disease with absolute equity across public, private and voluntary operated services. These teams of clinical specialists provided a range of advice and support throughout the period, including on-site assessments of residents' needs. The HSE also had to provide additional staffing, not only to its own facilities but also to private providers.

Public health and other guidance was issued across a range of measures, sometimes on a daily basis. A full nationwide personal protective equipment, PPE, logistical distribution system was formulated and deployed to all providers in a short timeframe, making what was a scarce commodity both here and internationally available in a fair and equitable manner to support demand in as far as possible.

Through the work of the area crisis management teams and Covid response teams, it is fair to say that tremendous work was undertaken in conjunction with staff of these residential facilities preparing for and dealing with Covid-19 related issues. Over 80% of long-term care facilities registered with HIQA are operated by private and voluntary providers. However, the HSE’s local knowledge, supplemented by HIQA’s knowledge of the sector, and the support it provided through the response teams, was critical throughout the period concerned. It assisted greatly in ensuring many of these facilities are now functioning normally once again.

The HSE did not have the opportunity of a dress rehearsal to plan for and manage this crisis. Covid-19 is a novel virus. Information is constantly evolving on how it is transmitted, how it presents in different age groups and how it can be present in people without symptoms. As with any disease, decisions are made at a point in time based on the available evidence and knowledge. We were receiving international advice and learnings from other countries simultaneously with our own experience of its spread across our population. This knowledge was changing on an ongoing basis throughout.

The committee has inquired about the learning from the events of the past six months in order to inform how we, as a nation, are prepared to address further outbreaks of this or other diseases. I have addressed this in my submission. It is clear there is a requirement for significant changes in the models of care used in this country to care for our most vulnerable older people. These changes require a concerted effort across policymakers, regulators, providers and clinical experts to achieve a safe and sustainable model of care into the future. Significant areas for development include assessing the overall governance arrangements for private nursing homes, further development of HSE support structures, funding models for long-term care and alternatives to long-term care.

I pay tribute to all healthcare workers in residential care settings, the staff who volunteered to support these services at critical stages, as well as the co-operation of the representative bodies which engaged positively with the HSE to support the flexible deployment of staff of all grades and professions. I also pay tribute to the community and family volunteers who continue to provide a bedrock of support to older people both at home and in care during these difficult times.

While we have the virus under control, it has not gone away and there is the risk of a second wave as the country further opens the economy and society. It is, therefore, vital that all the public health advice and guidance are followed by us all so we can continue to do everything we can to prevent the resurgence and spread of this deadly virus.

That concludes my statement. We are happy to take questions.