Mr. Tadhg Daly:

I wish the Chair and members of the joint committee good morning and thank them for the opportunity to meet with the committee today. Accompanying me, as the Chairman outlined, are Ms Deirdre Shanagher, clinical nurse expert with regulatory compliance, and Professor Dermot Power, Nursing Homes Ireland, NHI, gerontology expert.

We are here to represent over 400 private and voluntary nursing homes across the country which are integral for health and social care in Irish society. The past 11 months have represented a most arduous and upsetting time for all of us in the nursing homes sector.

The recent January 2021 data published by the National Public Health Emergency Team, NPHET, is a stark reminder of the indiscriminate nature of this deadly virus, with more cases of Covid-19 reported in January 2021 than the total number in the whole of 2020.

Nursing homes are home to people with the highest levels of frailty and with multiple underlying conditions. Worry and anxiety have been rife for the past year as staff and residents have lived with a virus that threatens their very lives.

Greater engagement and collaboration between the nursing home sector and our public health services has undoubtedly enhanced the supports available to nursing home residents and staff in the face of a global pandemic. This collaborative approach with key stakeholders, who are also attending this meeting, the HSE and Department of Health has included the provision of personal protective equipment, PPE, serial testing of staff and timely turnaround of results, provision of regular specialist Health Protection Surveillance Centre, HPSC, advice and guidance, the temporary assistance payment scheme, TAPS, and staffing when available.

The collaborative approach that was implemented following the onset of Covid-19, albeit delayed, remains in place, thankfully. However, the entire health service is under immense strain, with more than 6,000 staff absent due to the virus and in excess of 1,800 being unable to work within our nursing homes. Staffing is the predominant emergency that presents today across our health service. Within homes with outbreaks, available staff are going to extraordinary lengths at huge personal sacrifice to ensure continuity of care.

It should be noted that the majority of nursing homes, thankfully, are not experiencing an outbreak this time. Those that have outbreaks are severely constrained by the unprecedented circumstances, but thanks to the tremendous commitment by their teams, they are working through significant staffing challenges. The situation remains precarious.

The warnings from public health experts have been consistent and repeated. Heightened prevalence of Covid-19 in our communities presents an inevitable consequence for our health services and our nursing homes. In early December, the European Centre for Disease Prevention and Control, ECDC, warned about the epidemiological situation. Just two weeks ago, it highlighted that the new strains escalate transmissibility and, regrettably, bring with them higher mortality rates.

It is a great tragedy that Covid-19 has manifested again within our acute hospitals, nursing homes and all residential care settings, with tragic consequences for so many. Covid-19 is not particular to any class or type of setting. The new strains are highly transmissible across our health settings and within broader society.

A new beginning is slowly emerging. The roll-out of vaccination is bringing huge relief and hope within nursing homes. The biggest reaction among residents, staff and families is, thankfully, euphoria and it is important to acknowledge the contribution of the vaccination teams and all stakeholders in the roll-out. It has been a success throughout the country, with very positive feedback and very high levels of uptake being reported among residents and staff. However, we feel it is legitimate to ask if a critical window of opportunity was missed. With nursing home residents the most susceptible to the virus, just 10% of the initial 77,000 vaccinations administered by mid-January were within nursing homes. The committee will be aware that the national immunisation advisory committee agreed nursing home residents and staff would be priority 1. The first vaccines arrived in Ireland on 26 December, yet the first was only administered in a private or voluntary nursing home on 7 January. Every day is vital for our nursing home residents and staff.

A system also needs to be outlined with urgency for those residents and staff who missed the first dose of the vaccine due to having Covid and for new admissions to nursing homes from acute settings and the community. We remain engaged with a view to securing commitment from the HSE and public health to bring into effect immediately a policy to address this important issue.

Vaccination is bringing us towards a new dawn for the relatives and friends of nursing home residents. However, there is a way to go to protect our most vulnerable. The public health advice entails ongoing temporary but extended visitor restrictions, bringing tremendous pain and sorrow. Nursing homes have strived to ensure meaningful engagement has been supported through the homes and will continue to be guided by the public health advice. Based on our engagement with public health, the strong indication is enhanced infection prevention and control, IPC, measures will be required for some time. We cannot let our collective guard down as a society based on vaccination.

Today’s agenda encompasses supports for nursing home residents. I have spoken previously in the Oireachtas and to individual Members about the fair deal scheme, the requirement to publish the long-awaited pricing review which was due for publication in 2017, and reform of the funding model. HIQA needs to work with homes to better understand the severe challenges of the past year and those that present currently, and to work with providers and staff in a supportive and empathetic manner.

It is the opinion of Nursing Homes Ireland that an enduring legacy must emanate from the tragedy of Covid-19. Clearly, the enhanced collaboration and the teams of broader healthcare and social care professionals have come together in communities to support the delivery of highly specialised care to those in our nursing homes. Residential care of our ageing population cannot be allowed drift from the consciousness of the legislators responsible for health policy and resourcing. A number of significant issues remain in cul-de-sacs and we look forward to engagement in the months ahead on the broad reform agenda. The necessity to more tightly integrate nursing home care into our health services, a core recommendation presented by the Covid-19 nursing homes expert panel, must become an immediate priority. Our organisation is engaged with the reference group under the Department of Health to ensure this happens.

I thank the staff across the entire health and social care service, particularly those in our nursing homes, for their heroism in providing care to our most vulnerable during this pandemic. Great pride is assumed by people within our nursing homes in providing person-centred, compassionate care. It is important, and I know this has been highlighted by committee members, collectively and individually, by the expert panel and by the HIQA review, to pay tribute to staff, managers and owners for their dedication. We also take this opportunity to extend our sympathies to the families and loved ones of all residents and staff who have lost their lives because of this awful pandemic. For residents, my wish, I am sure it is shared by committee members, is that they soon will get back to a familiar norm of open visits, hugs and hope.