Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the Deputies for their valuable comments on this motion. The debate has been useful and will be of great benefit as the Department continues to progress proposals to enhance and improve services for older persons further.

I will pick up on a small, but key point made by Deputy Harkin that needs to be addressed by the Minister of State, Deputy Butler, and me. It has to do with recognising the valuable work and sleepless nights of nursing home owners and staff throughout Covid and the 100% they gave. It was not just staff and managers who had sleepless nights - the Ministers and Ministers of State who held those portfolios worked endlessly to ensure that supports could be put in place. We may have different views on how that can be best achieved, but we all want the same result, namely, ensuring that older people have access to safe, high-quality and effective care.

As the House will be aware, the Covid-19 nursing homes expert panel, which was established last year, provided a comprehensive report and package of recommendations regarding the ongoing response to Covid-19 and the longer term strategic reform of older persons care. Many of the short- and medium-term recommendations have already been implemented. Continued learning and understanding of the progression of the disease in Ireland is an integral part of these recommendations.

There have been various examinations and reports with a focus on Covid-19, its impact on nursing homes and the lessons from the pandemic that can inform future policy, regulation and the model of care for older persons.

There has been a clear national commitment to continue to learn from the pandemic as the national and international understanding of the virus evolves and, where necessary, to ensure that the public health-led approach evolves as evidence and learning materialises. The findings of these reports confirm that the infectious nature of Covid-19 makes it difficult to prevent and control in residential care settings. As mentioned by the Minister of State, Deputy Butler, Covid-19 is more likely to be introduced in residential settings where there are high levels of Covid-19 in the community.

In order to mitigate against these risks, the State has put in place a comprehensive set of public health measures, actions and responses to support nursing homes. Sustained communication and inter-agency co-operation remain central to the response to Covid-19 across the HSE, the National Treatment Purchase Fund, NTPF, HIQA and the Department. Guidance, 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.

I again assure the House that adult safeguarding is a matter of paramount importance for all of society, including all Government agencies and Departments. The safety and protection of adults at risk of abuse or harm by others is a fundamental priority for the health and social care sector. A strong focus has been placed on adult safeguarding within the health sector, especially in recent years. In the health sector, a framework of standards, policies and procedures for safeguarding of adults who may be at risk of abuse, harm and exploitation in health settings is in place and further measures are being developed to strengthen this framework.

The Health Information and Quality Authority is the statutory independent regulator in place for the nursing home sector, whether it is a HSE-managed or private nursing home. This responsibility is underpinned by a comprehensive quality framework comprising registration regulations, care and welfare regulations and national quality standards. HIQA, in discharging its duties, determines, through examination of all information available to it which includes site inspections, whether a nursing homes meets the regulations in order to achieve and maintain its registration status. If a nursing home is deemed to be non-compliant with the regulations and the national quality standards, it may either fail to achieve or lose its registration status. In addition, the chief inspector has wide discretion in deciding whether to impose conditions of registration on nursing homes.

Another important point raised by the Deputies is that of visiting. People living in nursing homes and other long-term residential care facilities had limited opportunities to welcome visitors for a period of time. This was an unfortunate but necessary measure to help protect residents and reduce the spread of the virus. However, as the Minister of State, Deputy Butler, said, following many incremental changes to the level of visiting that could be facilitated, we are expecting nursing homes to begin the return to normal visiting from next week. This is a welcome development and a positive indicator of the benefits that older people in nursing homes are experiencing as a result of the vaccination programme.

It is commendable that our colleagues across government and the House are committed to working towards safer care for older people. It is acknowledged there are aspects of older persons services that require improvement. In line with the programme for Government commitment, we will work to ensure the best possible safeguards are in place to protect our friends and family in nursing homes.

I will recap on some of the comments made by the Minister of State, Deputy Butler, and reiterate that enormous work has been undertaken to improve our older persons services. A comprehensive package of policy responses and support measures was developed and implemented to support nursing homes throughout the pandemic. Significant progress has been made on implementing the important recommendations of the nursing home expert panel. A third progress report on the implementation of the panel’s recommendations is being finalised. It notes the following developments. The IPC link practitioner programme framework has been finalised and phased implementation commenced in March 2021. Phase 3 of the safe staffing and skill mix framework commenced in August 2020. Phase 3 includes three distinct stages, the first of which will focus on nursing homes. A national task force, with representation from key stakeholders and agencies, has been established by the Minister to develop a framework for safe staffing and skill mix in long-term residential care settings for older persons. Funding has been provided to extend the research contract supporting the development of a framework for safe nurse staffing and skill mix across various areas for another three years. The HSE Covid-19 teams remain in place and continue to actively support prevention, preparedness and management of outbreaks, irrespective of whether facilities are operated by public, private or voluntary providers. In parallel, work is under way to progress the establishment of community support teams.

As the Minister of State, Deputy Butler, outlined, a range of legislative proposals is being brought forward which will enhance the governance and oversight of nursing homes and improve the reporting of key operational data. All of these positive developments, in addition to the wider reform of older persons services, will increase safety and oversight in the nursing home sector.

We know that people living in Ireland are living longer than ever before and we must ensure they live and age well. Therefore, it is clear that continued investment in our services for older people, including home care, is vital. The overarching policy of the Government is to support older people to live with dignity and independence in their own homes and communities for as long as possible. The continued development of a new statutory scheme for the financing and regulation of home support services is a key enabler towards achieving this aim.

The pilot of a reformed model of service delivery for home supports is due to commence this year. The Government has made improved access to home support services a priority. This is reflected in the unprecedented level of investment, secured by the Minister of State, Deputy Butler, for these services in budget 2021. Some 5 million additional home support hours will be provided for in communities throughout Ireland this year. Some €632 million was allocated in funding in 2021 and will provide for a total of 24 million hours of home support. The increased investment will contribute to meeting the programme for Government commitment to providing equitable access to home support services. There has been a significant reduction in the number of people assessed and waiting on funding for home support throughout 2020 and into 2021, with additional hours being delivered.

I look forward to supporting the significant work which is in train to further improve older persons services. I thank the Members once again for the opportunity to speak on this matter. I express my sympathies to the families who have lost loved ones during Covid-19.

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