Ms Yvonne O'Neill:

I thank the committee for the invitation to come before it this morning. Members have already been introduced to my colleagues, Dr. Siobhán Kennelly, the clinical lead for older persons, and Ms Sandra Tuohy, who is our head of operations for older persons. I start by acknowledging the professionalism, dedication and commitment throughout the pandemic of all healthcare workers and volunteers, particularly those working with older persons in nursing and care homes, whether public, voluntary or private. I extend my sincere sympathies to our healthcare workers who have lost colleagues and to all families who have lost loved ones to the virus, particularly today those who are residents of nursing homes where the impact of Covid-19 has been felt so severely.

When we attended in mid-June, a detailed paper was submitted to the committee which captured the roles and responsibilities and the substantive level of collaborative engagement across the system between the HSE, the Health Information and Quality Authority, HIQA, the Department of Health, Nursing Homes Ireland and other providers, all with the singular mandate of safeguarding the health and well-being of older persons living in long-term residential care. At that time in June the virus was relatively under control, with the then risk of a second wave as the country further opened the economy and society.

Public health reported data in mid-June indicated active outbreaks in less than 6% of nursing homes, characterised by largely smaller levels of detection in residents and staff. The response now required to the outbreak levels experienced in the current wave since December covering nearly 30% of nursing homes has relied on continued and enhanced collaboration across these stakeholders to support all facilities now impacted by the increased rates and virulence of Covid-19 community transmissions.

We understand that the committee members want a specific focus today on a number of themes and so the remainder of this statement will follow in that order.

Evidence in Ireland and globally has shown that older people, particularly those who are medically compromised or frail, are at severe risk for poorer outcomes from Covid-19 and that congregated settings such as nursing homes have been particularly impacted. Throughout the pandemic nursing home residents, their friends and families have been severely restricted in their social interactions and personal contact. Both in our professional roles and our private lives we appreciate the impact of those restrictions on the well-being of our loved ones.

Approximately 32,000 of our older population live in one of the 572 nursing homes currently registered by HIQA, with 81% of beds operated by private providers. It should be noted that a considerable number of those have remained Covid free and for many which did experience outbreaks these were managed very well.

From our public health data we know that 81% of all notified deaths in health service settings in Ireland from Covid-19 occurred in nursing homes and, sadly, we have lost the lives of more than 1,500 nursing home residents as a result of Covid-19.

The pandemic continues to pose extreme challenges to the delivery of health care services nationally with the rise in community infections across the Christmas period compounding challenges with regard to maintaining a safe, effective service delivery across the nursing home sector where there are approximately 2,000 staff on Covid leave across the largest outbreaks in more than 100 facilities. At 1 February 2021, there were 193 reported open outbreaks.

The HSE has directed maximal efforts towards the management of these outbreaks. In line with recommendations from NPHET, the HSE has rapidly stood up and continues to provide a range of supports including clinical advice, infection prevention and control guidance, access to staff training and education, prioritisation of staff for testing, supply of personal protective equipment, PPE, temporary staff accommodation and redeployment of HSE staff in exceptional cases to ensure continued safe care. In the last reported week ending 21 January 3,000 bed nights were provided in that staff accommodation, 60% of which related to a private nursing home staff.

Between the first and second waves a considerable number of webinars have been offered by the HSE and attended by hundreds of providers and their staff, in addition to a dedicated website for all related guidance. That is in parallel with continued operation of fortnightly serial testing of all nursing home staff, increased to weekly for the two weeks at the height of the current wave of Covid. The current seventh cycle of serial testing is indicating a detection rate of 2.3% of all staff tested.

During the first wave of the pandemic the HSE established a number of Covid-19 response teams with multidisciplinary specialist expertise who continue to work with all nursing homes - public and private - and play a critical role with the public health outbreak control teams in responding to, managing and containing outbreaks. There are currently 23 Covid response teams actively supporting nursing homes and these include infection prevention and control expertise, older persons service managers, consultant geriatricians and nursing staff. The Covid response teams can, if necessary, be flexibly enhanced with additional skill sets depending on the nature and setting of the outbreak in question, such as palliative care, and can also assist facilities with deployment of additional staff where necessary. Currently, there are nearly 200 HSE staff redeployed to older persons residential services and more than 60 of those related to private facilities.

The HSE has continued to supply PPE to all nursing homes in accordance with clinical guidance for both precautionary and Covid positive levels and also regardless of whether they are public, voluntarily or privately run. Measures are in place to increase PPE distribution for high demand items. The situation is monitored on an ongoing basis and guidance updated as required.

The very infectious nature of Covid-19 makes it difficult to prevent and control in residential care settings. In order to safeguard residents and staff, the HSE has, through the Health Protection Surveillance Centre, HPSC, issued guidelines on visits. These guidelines are reviewed to reflect current public health advice and NPHET recommendations. As contact with family and friends is essential to residents’ well-being, these guidelines have at all times sought to balance competing challenges in order to serve the needs of residents, as well as incorporating expanded definitions of critical and compassionate circumstances based on experiences to date.

In addition to the previously outlined supports, the ongoing vaccination programme continues to provide a source of hope and positive development within older persons services during this difficult time. Today, 575 nursing homes across the country will have participated in the first dose programme of the vaccination with the plan for both delivery of the remaining dose 1 residents and staff who could not be vaccinated due to clinical presentation and the dose 2 programme to follow within the indicated timelines, dependent on vaccine supply.

While this continues to be a difficult time for all, it is vital that the work completed to date by our colleagues, clinical and non-clinical, is acknowledged. The HSE will continue to divert all of its efforts to managing the current crisis and maintaining safe, patient-focused service delivery.