Oireachtas Joint and Select Committees
Thursday, 10 September 2020
Special Committee on Covid-19 Response
Examination of HIQA Report on the Impact of Covid-19 on Nursing Homes in Ireland
Ms Mary Dunnion:
There have thus far been three meetings with the Department of Health about the nursing home expert recommendations. A structured meeting schedule and implementation action plan are now in place under the direct chairmanship of the Department. An oversight committee is yet to be put in place.
That is in train. There are some immediate actions that will be taken and others are scheduled over the next 18 months or so. That is in place. My colleague will give the actual numbers.
As a regulator, we have learned that we can only work within the legal framework that we have, which the members, as legislators, will understand. We cannot work outside that framework. The only decisions and judgments we can make relate to compliance with regulations. We have, therefore, identified and outlined ten key regulations specific to Covid-19, which, if they were enhanced, would give us stronger oversight of the quality and safety of services in that regard.
We have been asked about isolation facilities, etc. By way of an example, if we register a nursing home that has 60 beds, the provider is registered to provide 60 beds to accommodate 60 residents. If our inspectors find that there is an issue with the quality and safety of care and recommend that there should only be 50 residents in that nursing home, it will take 56 days before we are able to enforce that condition. Included in the recommendations that we have suggested in writing to the Minister and Department is that the primary legislation needs to be looked at. It needs two key changes, although I accept that there are much longer-term legislative and policy changes required. There are two specific legislative changes in the area of primary care that would create a safety net for residents, providers, policymakers, the Government and the general public in the context of Covid-19. The first is that we should be given powers to immediately place a condition on a nursing home's registration. That would not negate a provider's constitutional right to an appeal but it would mean that a condition would be put in place while allowing the provider to appeal thereafter. As a consequence of the evidence we would gather, it would allow us to do that.
The second change would be to have compliance plans. The committee can already see that some regulatory authorities, such as the Food Safety Authority of Ireland, have such plans. That would provide a strong assurance to the Government, members of the public, providers and residents. As I say, that does not take away the right of appeal but allows an action to be taken before the completion of an appeal.
Those are some of the elements we have included in the ten regulations we have outlined. They are very much focused on the issues we have talked about, including premises, healthcare, staffing, governance and management, infection control, risk management and all the elements a provider must have in place to assure the quality of the service. It is important to remember that, in the legislation, the responsible entity for the provision of care is the registered provider. HIQA, as regulator, is the third line of defence. The first line is those delivering the care and the second is the person governing the care. Professional and systems regulators, such as HIQA, then have a part to play.
We have learned other lessons. We will be provide webinars for all providers and senior staff across the nursing home sector. As the Deputy said, there are 570 nursing homes in the country and 1,200 designated centres for adults and children with disabilities which also fall under our remit. These adults and children are also a vulnerable group in the current pandemic and public health emergency. We will provide webinars in conjunction with the HSE and the Health Protection Surveillance Centre, HPSC, to enforce and give direction and support to private and public bodies in the context of the provision of care. As Mr. Quinn has outlined, 4,500 people have already used our online infection control and prevention training programme. There is quite an amount that we have already done and identified and, as is the case with everybody else, there is quite an amount that we will hold up our hands and admit we have learned and to which we have adapted accordingly.
I will hand over to my colleague, Ms Cliffe, who will answer that question on quantum. I thank the Deputy.