Dr. Kathleen MacLellan:

As outlined, I am accompanied by Professor Cecily Kelleher, Ms Yvonne O'Neill, Mr. Niall Redmond and Ms Sarah Cooney. This is the second year of the Covid-19 pandemic in which, of the more than 120 million cases worldwide, more than 230,000 have been in Ireland. Sadly, more than 2.6 million people have lost their lives, including 4,587 in Ireland, of whom 2,009 have been in nursing homes. The continuing levels of high daily case numbers remain of ongoing concern.

Nationally and internationally, older people and particularly those in nursing homes have been especially impacted. Nursing homes are where more than 30,000 of our citizens call home and residents of nursing homes are vulnerable to Covid-19 for a variety of reasons. Consistent with the learning arising from the pandemic to date, the European Centre for Disease Prevention and Control, ECDC, the expert panel and HIQA highlight that the probability of Covid-19 introduction into these settings depends on the level of Covid-19 circulation in the community. Ireland has put in place a comprehensive set of public health measures, actions and responses that align with each of the ECDC-advised options to help manage and mitigate this risk to residents of long-term residential care.

Sustained communication and interagency co-operation remain central to the response to Covid-19. Guidance, personal protective equipment, PPE, 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. Fundamental to this is the continued and determined professional care provided by healthcare workers in nursing homes 24 hours a day. Throughout the pandemic to date, about one third of nursing homes have remained Covid-outbreak free, while many nursing homes that did experience an outbreak managed very well.

While there is much to be hopeful about following the Government prioritisation of vaccination of older people and healthcare workers, the challenges associated with the pandemic will continue for the foreseeable future. A vaccination effect is being seen, however, and the number of open outbreaks in nursing homes now stands at 68, down from 178 on 21 February. In addition, this week sees a significant step in restoring meaningful contact through enhanced visiting guidance for nursing homes, whereby each resident can now have two face-to-face visits a week in light of a high rate of vaccination in the nursing home.

Following the recommendation of the National Public Health Emergency Team, NPHET, in May 2020, a Covid-19 expert panel on nursing homes was established to provide immediate, real-time learnings to the Minister for Health. This panel made a substantial package of 86 recommendations in 15 thematic areas and was published on 19 August. The Minister for Health and the Minister of State with responsibility for mental health and older people committed to progressing these recommendations and established an implementation framework with a priority focus on key short-term public health and protective measures. This framework includes an interagency implementation oversight team and a stakeholder reference group. Early progress on implementation of recommendations is evident and a second progress report has been published. In summary, the areas worth highlighting include assurance of the ongoing HIQA and HSE public health supports and in particular the role of serial testing and Covid response teams, the governance systems put in place by the HSE and HIQA, additional funding for the provision of integrated infection prevention and control measures, the delivery of sustained and intensive education and information campaigns and the establishment and preliminary work of the task force on safe staffing.

A paper reviewing Ireland’s actions in light of the key national options in respect of mitigating and managing Covid-19 in long-term care has aligned well to the November ECDC risk assessment, and this paper was published and discussed by NPHET. In regard to regulation, the Department is in broad agreement with the recommendations of the expert panel and HIQA with regard to the need to enhance the current regulatory frameworks for older people and the need to reform the regulatory model. Over recent months, the Department has sanctioned additional inspectorate staff for HIQA to support a sustained increase in the frequency of inspections. The Minister for Health has approved the development of interim enhancements to the current regulatory framework for nursing homes this year, with a view to commencing a longer-term review of nursing home regulation in 2022, and recently requested that HIQA undertake an up-to-date international evidence review of nursing home regulatory models to support and inform this wider review.

In the meantime, the Department is focused on interim enhancements to the legislation through a bilateral project group supported by HIQA. Detailed work is advancing on legislative proposals that, subject to Government approval, will aim to enhance the enforcement and oversight powers of the chief inspector, including through additional enforcement tools such as compliance notices, obligations for all nursing homes to report key operational data to HIQA and make the data public, exploration of measures to enhance transparency, and increased legal underpinning of infection prevention and control obligations, along with other improvements.

Home care is essential to support older people to live in their homes for as long as possible. Investment in home support services has increased by 66% since 2017 and more than €666 million has been allocated in 2021 to provide 24 million home support hours to 56,000 people. This includes 360,000 hours for intensive home care packages. In addition, the HSE national service plan commits €10 million to the roll-out of the interRAI standard assessment tool and to establish a national home support office. A programme of work to advance the statutory home support scheme is well under way. The Government will soon be asked to approve the principle of moving to introduce a licensing framework for professional home support providers, underpinned by legislation, in line with the programme for Government commitment. Throughout 2021, the Economic and Social Research Institute, ESRI, is conducting research on behalf of the Department on the projected demand for, and cost of, home support provision across a range of models for the financing of the statutory home support scheme.

This work will build on projections for the future demand for home support as set out in various reports, including the Department of Health's Health Service Capacity Review 2018, which forecast that a 120% increase in home support services will be required by 2031 if the health system is fully reformed.

In summary, Covid-19 has highlighted the important need to move to new models of care for older people. This will involve short and long-term reform across government in order to provide new housing models, new home first care models and where long-term care is needed, that it is provided with innovative designs that can meet infection prevention and control requirements and provide a home for those who need this type of care. The HSE’s national service plan also fully recognises pandemic learning and the reform requirements, including commitments to commence planning towards a longer term rebalancing of the public-private nursing home mix. Sláintecare provides the overall framework of right care, right place, right time in order to support older people to continue to live in the community in their own homes for as long as possible, thereby participating to their full potential in economic and social life.