Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Deputies for raising this important matter. The Covid-19 pandemic has led to an unprecedented challenge across our health services, nowhere more so than in our nursing homes. It has been an incredibly difficult time and we are all acutely aware of the huge sacrifices made by people living in nursing homes, their families and staff. It is fair to say that the health and safety of residents in nursing homes has been paramount in all our minds over the last 16 months.

Nursing homes are a key provider of care to older people in Ireland and over 30,000 of our citizens call them home. Those living in nursing homes are considered vulnerable to Covid-19 due to a variety of factors, including 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.

As well as this, learning arising from the pandemic to date has highlighted that Covid-19 is much more likely to be introduced into residential settings where there are high levels of Covid-19 in the community.

Over the course of the pandemic, restrictions to visiting in nursing homes have been necessary to reduce the risk of spread of infection and to protect residents who may be vulnerable to the virus. However, visiting is part of the normal daily functioning of nursing homes. Meaningful social contact is important to our well-being and is something that we have striven to provide as safely as possible.

In communicating with nursing home providers, I have continuously reiterated the need to ensure that visits take place to the greatest extent possible, in line with evolving visitation guidance, public health advice and risk assessments. Visiting under compassionate circumstances has been maintained under all levels of the Government’s framework during the pandemic. I have also encouraged providers to communicate frequently with residents and families about visiting and to respond to telephone calls by family members as much as possible, given the constraints that staff were working under.

Thankfully, Covid-19 cases and outbreaks in nursing homes are at a low level, largely due to the positive impact of the vaccination programme. I am pleased to be in a position to report that updated guidance on visiting in nursing homes comes into effect from next Monday, 19 July. This is a significant step forward to a return to more normalised visiting for people living in nursing homes and their families. Vigilance must be maintained, as we continue to deal with the risks associated with Covid-19, and visiting should continue in line with public health advice and the necessary infection prevention and control, IPC, measures.

In another positive development, significant regulatory reform is ongoing in conjunction with the Health Information and Quality Authority, HIQA, and is in line with the Covid-19 nursing homes expert panel’s recommendations and lessons learned from the pandemic. In April 2021, the Government agreed the progression of interim enhancements to the current regulatory framework for nursing homes, which will occur this year. These proposals aim to enhance the enforcement and oversight powers of the chief inspector of HIQA.

With regard to safeguarding issues, I assure the House that the Government takes matters and allegations of neglect and abuse seriously. There are various structures and processes available to protect against abuse and poor care standards, and to ensure prompt action, including through the independent ongoing regulation and inspection of nursing homes by HIQA. To this end, I met representatives of HIQA last Friday. Safeguarding adults at risk in the context of their interactions with the sector is a key objective of the Department of Health, every statutory body under its aegis and every health and social care service that interacts with such adults. Where abuse is a potentially criminal matter, it is the full expectation of the Department and me that any such instances in our health and social care services would be referred to An Garda Síochána in the first instance and investigated accordingly.

The Department is at an advanced stage in developing its national adult safeguarding policy for the health and social care sector. Extensive policy development work, including stakeholder engagement and detailed research, has been concluded. This includes service user focus group research and a major international evidence review, published earlier this year. Legislation to underpin this policy will be developed. A range of structures and processes has been established by the HSE to support and further develop its national operational safeguarding policy.

A key principle of safeguarding is that it is everyone’s business and that all healthcare professionals have key roles in the prevention and reporting of abuse. The essential role of social workers in safeguarding is recognised. The specialist safeguarding and protection teams in each of the nine HSE community healthcare organisation areas are managed and led by principal social workers and staffed by social work team leaders with professionally qualified social workers. These teams provide a range of safeguarding functions, from direct case management to quality assurance, as well as oversight and support to all service providers, including those funded by the HSE. Community support teams, as recommended by the nursing homes expert panel, will be implemented across each community healthcare organisation and each of these teams will have access to dedicated social worker resources through enhancements of existing community safeguarding teams.

As the House will be aware, nursing home providers are ultimately responsible for the safe care of their residents. Since 2009, HIQA is the statutory independent regulator in place for the nursing home sector, whether in a HSE-managed or a private nursing home. The authority, established under the Health Act 2007, has significant and wide-ranging powers up to and including withdrawing the registration of a nursing home facility, which means that it can no longer operate as a service provider.

The Covid-19 nursing homes expert panel made a substantial package of recommendations, which also reflects that systematic reform in the way nursing home care, and health and social care for older persons more broadly, are delivered and financed. Many of the short and medium-term recommendations have already been implemented. A number of these relate to the delivery of a broad suite of supports provided to private nursing homes, including free personal protection equipment, PPE; serial testing; HSE Covid-19 response teams; IPC measures and training; and temporary accommodation for staff. The significant examination undertaken by the expert panel provides important learning and a framework for enhancing older persons' services both in the short and long-term, and this work is progressing.

It must be recognised that the pandemic has not concluded. The ongoing management of the Covid-19 response remains a priority focus of the Government to ensure the positive gains being experienced are preserved and those most vulnerable to the virus continue to be safeguarded in light of the residual risk. This week, I met family members of people who sadly passed away in nursing homes. The Department is continuing to look at options which may be available to the State to listen to the voices of those who have lost a loved one. I conclude by expressing my sincere condolences to those who have lost a loved one during the pandemic.

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