Mr. Phelim Quinn:

I welcome this opportunity to address the Special Committee on Covid-19 Response. I am joined by my colleagues, Ms Mary Dunnion, chief inspector of social services and director of regulation, and Ms Susan Cliffe, deputy chief inspector of social services.

In July, HIQA published a report on the impact of the Covid-19 pandemic on nursing homes in Ireland. The report details the initial findings of our inspections and interactions with nursing homes and describes the experiences of residents, their relatives and staff. The report outlines the significant level of activity that has occurred from March to the date of publication in July to ensure the safety and welfare of residents and to support service providers and staff.

This includes, for example, inspections of centres both with and without cases of Covid-19, the expedition of applications to open new nursing home beds, the receipt and review of a large number of mandatory notifications, and the opening of HIQA’s infection prevention and control hub.

Since the first case of Covid-19 was confirmed in an Irish nursing home on 13 March, HIQA has maintained regular and ongoing contact with the providers and managers of nursing homes and monitored their ability to protect residents and manage an outbreak of this nature. These facilities faced substantial challenges in the initial phase of the pandemic for the following reasons: they are not hospitals - good nursing homes provide a social model of care and are integrated into their local communities; the prevalence of Covid-19 in the community; initial limitations in accessing Covid-19 testing and prompt notification of results; limited working knowledge initially of the symptoms of Covid-19 and the extent of asymptomatic spread; the absence in some facilities of comprehensive plans to deal with the outbreaks; challenges in replacing staff due to the requirement for quarantine and self-isolation; the scarcity of personal protective equipment, PPE, across the health sector; infection prevention and control processes that were not commensurate with what would be required to effectively manage a pandemic; the need to understand and apply frequently changing national guidance on the management of Covid-19; and the fact that 80% of nursing homes are privately managed with minimal formal referral pathways to the HSE.

A key element of our inspections is listening to the views of people who live in nursing homes. On more recent inspections, residents who spoke to our inspectors expressed a range of emotions. Some feared contracting the virus and worried about their family and friends, while others felt a deep sense of isolation and loneliness as a result of the visiting restrictions. Without exception, residents were deeply grateful to staff in nursing homes for the care they provided in extremely challenging circumstances.

In the context of HIQA's role, Covid-19 has brought into sharp focus the need to immediately review and enhance the current regulatory framework. In the long term, a reform of established models of care for older people in Ireland is required. To this end, on 25 June, HIQA submitted to the Minister for Health a number of suggested interim amendments to the Health Act 2007 and the regulations for designated centres for older people, and adults and children with a disability.

HIQA contributed to the Covid-19 nursing homes expert panel report published on 19 August by the Minister for Health. This report contains a range of recommendations aimed at safeguarding residents in nursing homes. The report makes 86 recommendations, 24 of which are directly relevant to our role. HIQA has been identified as the lead agency in four recommendations, and is one of a number of agencies that will contribute to the implementation of a further 20 recommendations. A large number of recommendations require urgent implementation and-or planning for implementation to commence immediately. This is to maintain the focus on supporting nursing home residents, ensuring that older people, especially those at high risk of infection, are at the centre of the ongoing response to Covid-19.

Some of the recommendations involve enhancements to our current regulatory practice and schedule, such as an increase in the volume and frequency of on-site inspection activity to at least one inspection per centre per year and targeted Covid-19 preparedness inspections.

In addition, these recommendations will require the implementation of additional regulations and legislation or the amendment of current regulations; the identification of a suite of quality assurance metrics and mandatory notifications; the establishment of a number of new registers; publication of the results of specific audits; and an increase in HIQA's capacity, including our ICT resources. In addition, there is also a wide range of measures and actions to be undertaken that are the responsibility of individual nursing home providers.

I also acknowledge the publication of this committee’s interim report on Covid-19 in nursing homes. We agree with the statement made therein that the crisis has highlighted the need to move to a different model of care where older people are cared for in their own homes or their communities for as long as possible. We welcome the recommendations made in the report and are working with the Department of Health to ensure that HIQA has adequate resources to progress both these recommendations and those of the expert panel. A business case has been made to the Department of Health in this regard.

I thank the committee for its attention this morning. We look forward to answering any questions members may have.