Dr. Kathleen MacLellan:

I thank the Chairman and members. This year, 2020, has brought with it the most serious global pandemic in a century. Since the emergence of Covid-19, there have been more than 28 million cases of the disease worldwide. Some 30,500 of these have been in Ireland and, very sadly, 1,781 people here lost their lives.

Nursing homes are where more than 30,000 of our citizens call home. Residents of nursing homes are vulnerable because of their age, underlying medical conditions, the extent of their requirement for direct care involving close physical contact and the nature of living in congregated settings. Nursing homes have been particularly impacted upon by Covid-19, both in Ireland and internationally. For the past six months, nursing home residents, their friends and families have sacrificed the normal daily social and person-to-person interactions. It is with great sadness that I say that 994 nursing home residents lost their lives as a result of Covid-19.

It is essential to recognise the continued and determined professional care provided by healthcare workers in nursing homes 24 hours a day.  It is also important to appreciate that approximately half of nursing homes remained free of Covid-19 and that many of the nursing homes which did experience an outbreak managed very well. The central focus of the response of the National Public Health Emergency Team, NPHET, has been to control the spread of the virus insofar as possible to protect those who are most vulnerable from infection, as well as protecting against causes, situations, circumstances and behaviours that may lead to the spread of Covid-19.

New cases, both across the whole population and in nursing homes, have steadily declined over the past few  months. Unfortunately, we are now seeing a gradual change in the epidemiological situation and nursing homes have not remained unaffected. Since the start of pandemic and as of 10 September 2020, there have been 281 clusters in nursing homes. More than 85% of those clusters are now closed, with 39 remaining as open clusters. The open clusters are in areas of high community Covid-19 transmission, including 27 in the east of the country, ten in the mid-west and two in the north east. In the 14 days prior to 10 September, the Health Protection Surveillance Centre, HPSC, advised the Department that 1,997 new confirmed cases had been notified, with 10% of those cases involving people aged 65 years and older. There have been four new clusters in nursing homes in this timeframe.

It is of great concern that heightened community transmission may bring further unwitting transmission of Covid-19 into nursing homes, thereby impacting on those most vulnerable to the virus. Therefore, sustained communication and inter-agency co-operation must remain central to the response to the virus. Extensive ongoing and problem-solving collaboration between Nursing Homes Ireland, the HSE, the National Treatment Purchase Fund, the Health Information and Quality Authority and the Department continues. The State's responsibility to respond to the public health emergency created the need for the HSE to ensure a structured nursing home support system was in place in line with NPHET recommendations. This has been a critical intervention in supporting the resilience of the sector in meeting the unprecedented challenges associated with Covid-19. Guidance, personal protective equipment, staffing, serial testing, infection prevention and control training, accommodation and financial support have been provided to the nursing home sector, both public and private. In addition, multidisciplinary clinical supports are in place at community healthcare organisation, CHO, level through 23 Covid-19 response teams. 

HIQA has designed and implemented a regulatory assessment framework of the preparedness of designated centres for older people for a Covid-19 outbreak. In addition, the authority is in the process of developing an infection prevention and control assurance frameworkfor nursing homes, which will include a self-assessment tool for nursing homes and will be supported by an outreach training and support programme by HIQA. 

In continuing to monitor the national and international experience of Covid-19 in nursing homes, NPHET outlined its clear view of the need to ensure that all actions that can be taken are taken to protect residents of nursing homes.  NPHET therefore recommended, on 23 May, that a Covid-19 expert panel on nursing homesbe established by the Minister for Health. This panel was tasked with providing immediate real-time learnings and recommendations in light of the expected ongoing impact of the virus over the next 12 to 18 months. The panel has submitted its report to the Minister for Health, which included a substantial package of recommendations across 15 thematic areas. It contains 86 recommendations, with associated timelines, for implementation over the short, medium and long term by the HSE and associated agencies with responsibilities in this area. The report, which was published on 19August by the Department of Health, also contains a specific chapter on the model of care.

The Department has strongly welcomed the report and is fully committed to progressing its recommendations. The Minister for Health has already established an implementation framework which will ensure a priority focus on key short-term public health and protective measures for nursing home residents over the coming months, with a particular emphasis on winter and ongoing preparedness against Covid-19. The framework includes an implementation oversight team and a reference group. The oversight team has met twice already and will report monthly to the Minister to outline progress and any challenges for escalation. The reference group will hold its first meeting next Monday.

Early progress on some recommendations has been made, including the commencement of a costing exercise, an additional funding allocation for infection prevention and control, plans to test the safe staffing framework, an ongoing commitment from the HSE and HIQA to implement the public health measures, commencement of the design of a visiting guidance framework, commencement of a review of the current HIQA regulations, and ongoing serial testing in nursing homes.

In conclusion, the Government's plan for living with Covid-19 places an important focus on supports for the nursing home sector. These supports include the continuation of the Covid-19 response teams, implementation of the safe staffing framework, an extension of the temporary financial support scheme and progression of the implementation of the expert panel recommendations, with particular focus on those recommendations requiring urgent and immediate attention in order to ensure all available measures to protect this vulnerable cohort are taken.