Dr. Kathleen MacLellan:

I thank the Chairman and members. I am joined by Niall Redmond, who is principal officer in services for older people.

The year 2020 brought with it the most serious global pandemic in a century. Since its emergence, there have been more than 100 million Covid-19 cases worldwide, with almost 200,000 of these in Ireland where, very sadly, more than 3,000 people have lost their lives. One third of these lives have been lost in the past month. While there is much to be hopeful about, challenges associated with the pandemic will continue for the foreseeable future.

Nursing homes have been particularly affected by Covid-19 in Ireland and internationally, where residents and families, in balancing protective and supportive measures, have lived without the normal daily social and person to person interactions. It is with great sadness that 1,543 people have lost their lives to Covid-19 in nursing homes; 369 of these in the past month. It is important to recognise the continued and determined professional care provided by our healthcare workers in nursing homes 24 hours a day. The Government prioritisation of vaccination for residents and staff in nursing homes brings a strong sign of hope. Nursing homes are where more than 30,000 of our citizens call home. Residents of nursing homes are vulnerable to Covid-19 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.

The ECDC risk assessment in November reiterated the overarching message that residents of long-term residential care services are one of the most vulnerable populations and continued focus should be placed on preventing Covid-19 from being introduced into such facilities and on the control of outbreaks when they do occur. Consistent with the learning arising from the pandemic to date, the ECDC highlights that the probability of Covid-19 introduction into these setting depends on the level of Covid-19 circulation in the community. Consistent with the recent and current levels of community infection, unfortunately nursing home impacts can be seen, with a fivefold increase in open outbreaks from 34 in mid-December to 193 by the end of January. However, it is also important to appreciate that approximately 40% of our nursing homes remained Covid-19 outbreak free and many nursing homes that did experience an outbreak managed very well. The central focus of NPHET's response has been to control the spread of the virus in so far 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.

Sustained communication and interagency co-operation remain central to the response to Covid-19. Extensive, ongoing and problem-solving collaboration between stakeholders, the HSE, the National Treatment Purchase Fund, HIQA and the Department continues. The State’s responsibility to respond to the public health emergency created the need for the HSE to establish a structured nursing home support system 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 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 and an infection prevention and control assurance frameworkfor nursing homes, which includes a self-assessment tool and support programme.

Following a NPHET recommendation in May 2020, a Covid-19 expert panel on nursing homes was established by the Minister for Health. This panel was tasked with providing immediate real-time learnings and submitted its report to the Minister for Health, making a substantial package of 86 recommendations across 15 thematic areas. The report was published on 19 August. The Minister for Health and the Minister of State with responsibility for mental health and older people are committed to progressing the recommendations and have established an implementation framework with a priority focus on those key short-term public health and protective measures. This framework includes an inter-agency implementation oversight team and a stakeholder reference group, which have met 11 times and seven times respectively. A second progress report is being finalised and early progress has been made on the recommendations, as I will set out.

An additional funding allocation for the provision of integrated infection prevention and control has been made to the HSE. There has been advanced planning for testing the safe staffing framework. There is an ongoing commitment by the HSE and HIQA to continue the public health support measures. Additional inspectorate staff for HIQA have been sanctioned to support increased frequency of inspections. A review of the current nursing home-related legislation, with a particular focus on enhanced regulator powers and oversight, has been commenced and work across HIQA and the Department is ongoing. There is ongoing serial Covid-19 testing in nursing homes. A framework document on the roles and responsibilities of the various agencies has been published. There has been provision of extensive education, including a dedicated web page with all nursing home education resources in one place.

It is important that a paper reviewing Ireland’s actions in light of the key national options in mitigating and managing Covid-19 in long-term care provided by the November ECDC risk assessment has been developed and discussed by NPHET. The ECDC outlines the need to take a systems level approach to supporting the prevention, introduction and transmission of Covid-19, noting that no single intervention or response, but instead a co-ordinated package of interventions, is required to successfully tackle the virus. This paper has been published.

In summary, across all options identified by the ECDC, Ireland has in place a comprehensive set of public health measures, actions and responses that align with each of the ECDC options. These are either direct actions or supports undertaken by State agencies and public health authorities or are measures aimed at supporting and facilitating individual nursing homes. It is likely that the effect of these actions, building on the evolving knowledge of the disease, has had over time a positive effect on the levels and impact of Covid-19 in long-term residential care. As presented by the Irish epidemiological modelling group, the number of cases in long-term care was smaller in the second wave compared with the first. However, the number of cases linked to long-term care following unprecedented levels of infection in the community is now very high, similar to the numbers seen in April and May 2020. Nonetheless, when compared with the total burden of disease in the community and total cases per week, the level of infection is significantly less than in April and May 2020.

In conclusion, the Government's plan for living with Covid-19 places an important focus on supports for the nursing home sector, both in the short term and for the longer-term development of the future model of care. These supports include the continuation of the various supports I have outlined in the opening statement. The focus of the programme for Government has been on the development of the future model of care. It is very important today, as we reflect on what has happened during the pandemic, that we focus our efforts on supporting new and renewed models for older person care.