Professor Cecily Kelleher:

I thank the Chair and members of the Oireachtas committee for their invitation to attend this morning.

COVID-19 presents, as we all know, a significant global threat to public health and the WHO declared a pandemic on 11 March 2020. As of 14 July 2020, for the purposes of our report, 79% of all notified deaths were in those aged over 75 years. The 985 deaths in nursing homes represented 56% of all deaths in the Republic of Ireland. We, as a society, mourn their loss and offer condolences to the families and loved ones of all those who lost someone during this period.

The four person independent expert panel was appointed by the Minister for Health on 20 May to examine the complex issues in this particularly vulnerable group of nursing home residents. We were tasked to provide assurance that national protective measures were in place in line with international guidelines and best practice; to review International evidence using a systematic research process; and, to report to the Minister on immediate real-time learnings and provide recommendations. The panel took an evidence-based and consultative approach to our work. This was an in-action and after-action review that took account of lessons learned and preparedness, and was forward looking.

We requested an analysis of available epidemiological data from the Health Protection Surveillance Centre and the Department of Health.

At UCD, my team undertook a rapid, systematic review of international literature on older people in long-stay care centres. We also undertook a three-part stakeholder consultation over the month of June. We held 13 meetings with 43 people from key groups and received a further 37 submissions. In addition, we received 53 submissions from nursing homes and 60 public submissions. Finally, we undertook three nursing home site visits, one actual and two virtual, with the person in charge and staff. Panel members also had engagement with several residents and relatives.

We know that 5% of those aged 65 and over live in communal establishments. HIQA, the Health Information and Quality Authority, is the regulator for this sector and, as of summer 2020, had 576 registered nursing homes, 444 of which were privately-owned, and 3.6% of the over-65 population reside there. The first notified case in the sector was on 16 March. As of 27 June, 252 clusters had been reported, which represented 18% of all clusters at the time and they were associated with 5,608 cases. Notably, the highest number of clusters were in the more densely populated eastern region. The estimated incidence rate, at 14.5%, was greatly higher than in the general population of comparable age.

The evidence review showed that, despite a limited database to date with a new disease, the importance of infection prevention and control measures was repeatedly highlighted. All stakeholders who consulted with us stressed the need for preparedness. This included discussion on timeliness of response both then and into the future, the challenges of managing a new disease, and the critical public health measures that must be in place. I stress, this is a highly contagious novel virus with continuously evolving understanding of its epidemiology. The significance of asymptomatic spread and atypical presentation in older people was not understood early in the pandemic. The rapidity of spread in frail, older people in a congregated setting was a feature in Ireland and elsewhere across the world. Consideration of the well-being of residents and their voices, and those of their family members, in management structures was emphasised. Preparedness for the next 18 months will be crucial, with a necessary focus on this sector immediately as part of winter planning.

There was also emphasis in the submissions on lessons learned about the model of care for older people more generally. Many submissions focused on the implications for a future model of care. The interdisciplinary co-operation in response to the crisis presented a model for future delivery. The importance of representation of older people in their care and the place of advocacy were stressed. Nursing homes into the future should be part of a continuous spectrum of care of the older person with provision of multidisciplinary support.

It was clear from a range of stakeholders we consulted that healthcare staff worked tirelessly for the residents and all parties, including carer staff, and they now require a range of supports, which we stress in our reports. Great value was placed on the services "stood up" to cope, especially Covid-19 response teams. These supports must be sustained and regularised over the next 18 months. This is a multifactorial challenge and we must be action driven. The recommendations must also reflect that systematic reform is needed in the way care is delivered into the future.

Each area of recommendation in 15 thematic areas has a suggested clear lead agency and timeframe for implementation. We list some examples for discussion in our presentation. This ranges from immediate and ongoing to within two years of the publication of the report. Public health preparedness right now is essential by individual nursing homes supported by the HSE and HIQA.

We have an opportunity to address health policy for older people, with nursing homes playing a key part. There is an implementation plan in train now by the Department of Health which will be crucial to the delivery of the recommendations in this report. I thank the committee.