Darren O'Rourke (Meath East, Sinn Fein)
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I congratulate the Minister on his new role and wish him the very best. I mean that. As others have said, many people are really depending on him and the system needs all the support it can get. I thank the Minister for coming here to answer questions on the extremely important issue of the Kilbrew nursing home and the care of Ultan Meehan. His family want this issue raised at the very highest level. There has been extensive media coverage of this case in recent days but it is important that we remember there is a family at the centre which has lost a son and a husband. Our thoughts are with Mary Bartley Meehan and the wide circle of family and friends of her late and beloved husband, Ultan Meehan, and her late and beloved son, Adrian Bartley.

I was shocked and appalled when the details of Ultan Meehan's case came to my attention. Many but not all of the details are now in the public domain. Anyone who has read or heard them will be shocked and appalled. In early June, I contacted the HSE, HIQA and the previous Minister for Health, Deputy Harris, on the case. I spoke with officials in HIQA who advised me that an on-site inspection was being conducted on 4 June. This was a planned inspection. I was advised that I would receive a copy of the report in due course. I await that report. The HSE responded to say that it has no governance or oversight over private nursing homes as they are private organisations. The then Minister responded on 9 June to outline the legislative and regulatory framework and to acknowledge that HIQA has no legal role in examining individual complaints but takes a risk-based approach to regulation. He confirmed that he had requested the HSE to follow up directly with the nursing home in question and asked that the Department of Health be apprised of the situation and any actions taken. That report was to be shared with me but I have not yet received it.

This case raises several issues. It raises very serious questions around the care provided to Mr. Meehan at Kilbrew nursing home. It raises immediate questions about the care provided to other residents, past and present, in that setting. My clear understanding is that there is more information to come to light. It raises serious questions about the wider issue of regulation and oversight of private nursing homes. It will come as a shock to many people that the HSE has no role in the oversight of private nursing homes while HIQA cannot examine individual complaints, even those of an extreme nature.

I have specific questions and would appreciate specific answers. When was the Department of Health or the HSE first notified of concerns at Kilbrew nursing home or relating to the care of Mr. Meehan, and by whom? We understand that nursing homes around the country were under great pressure and crying out for help during Covid-19. Was that the case with Kilbrew? Has the Minister or his Department received the aforementioned reports from HIQA and the HSE? If so, what did they say about the situation in Kilbrew nursing home and any actions taken? How does the Minister propose to proceed? Will he commit tonight to a full independent rapid review of the clinical care provided to Ultan Meehan and related issues at Kilbrew nursing home? This should be done immediately and that is the wish of the family. It should be headed by a doctor, a consultant specialist in the area of medicine for the elderly. Will the Minister commit to that tonight?

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy O'Rourke for raising this and acknowledge his kind words. The Deputy has raised this issue and continues to do so, and is advocating strongly on it. It may be useful if I read out the official position which sets out the statutory framework on what is happening. Before I do so, I will answer the Deputy's questions directly. I took down three, but I think there were more. On when the Department was told of the issues, I will find out for the Deputy. This question was not included in his original Topical Issue. I do not know the answer but I will find it and revert to the Deputy. On whether we have a report, none has yet been submitted to my Department. We will examine it as soon as it arrives. On whether we will commit to a full independent review of the care, that is not where we are at right now. Currently, HIQA and the HSE are investigating the issue and officials in my Department are liaising with them on it. I believe that is what we must do now.

The Covid-19 pandemic has led to unprecedented challenges across our health service and none more than in older persons services. The health and safety of residents in nursing homes has been paramount in all our minds in recent months. The National Public Heath Emergency Team, NPHET, the HSE and HIQA have placed a focus on supporting older people from the outset of the pandemic. Every person who is supported by older persons services is entitled to expect and receive support of the highest standard. Quality care and patient safety is a priority and a continued focus and must always be delivered safely and to a high quality. Nursing home providers are ultimately responsible. We have regulators, the HSE, the Department and the Oireachtas, but nursing home providers are responsible for the care they provide to their residents. HIQA has been in place since 2009 as the statutory independent regulator for the nursing home sector, including HSE-managed and private nursing homes. It was established under the Health Act 2007 and has significant and wide-ranging powers up to and including the registration of a nursing home facility.

This means that a nursing home cannot operate as a nursing home without such registration. It has essentially graduated powers up to the point of shutting nursing homes down. This responsibility is underpinned by a comprehensive quality framework comprising of the restriction regulation, care and welfare regulation, and the national quality standards. HIQA, in discharging its duties, determines through the examination of all of the information available to it, including site inspections, whether a nursing home meets the regulations in order to achieve and maintain its registration status. Should a nursing home be 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-ranging discretion in deciding whether to impose conditions of registration on nursing homes.

During the Covid-19 pandemic, nursing homes continue to be regulated by HIQA, which, under the 2007 Act has the legal authority to examine the operation of any facility under its remit. In addition, a series of enhanced measures have been agreed by NPHET for long-term residential care settings and these are being implemented at the moment.

As for this particular nursing home, I can confirm that the Department has received correspondence, including from the Deputy, on this matter and has forwarded these details to HIQA as the statutory regulator for nursing homes and to the HSE for appropriate action and follow-up. I also have asked my officials to engage with both HIQA and the HSE to follow up on this matter.

Darren O'Rourke (Meath East, Sinn Fein)
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I thank the Minister for his reply. I return to the issue of the reports and planning as to where we go from here. That is really important and I do not want to leave that point. The family seeks an independent review of this case and this needs to remain on the table here, notwithstanding the fact that the HSE and HIQA are involved in this. Can the Minister indicate what the HIQA and HSE timelines are? A month has now passed. Is the Minister satisfied that this is an isolated incident? I do not believe that he can be confident that it is and this is the concern that people will have in this regard. Can the Minister further outline what plans he has for the broader regulatory framework for our nursing homes? This case highlights an anomaly, a loophole and a gap in the regulation and oversight. While many legal experts are calling for robust and strong safeguarding legislation, I principally require some clarity on the timeline. What timeline can we expect here and when will a report be available and published? On that point, was the Kilbrew nursing home crying out for help? Did it make repeated contact with the HSE or it is the case that this went below the radar? I implore the Minister, in my final ten seconds, that as this is shocking stuff, it needs the full weight of his Ministry to see it resolved.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy and I am with him in this regard. I wish to acknowledge the pain and suffering of the Meehan family. The situation and the case we all saw reported is heartbreaking and shocking. I cannot begin to imagine what the Meehan family have been going through over the past few months. We owe it to them and to every resident in every nursing home to ensure there is a consistently high quality of care and that when people see issues, they can raise a flag in the knowledge that those issues will be taken seriously and will be reacted to.

The Deputy and Members will understand that I cannot go into too much detail here in public about any individual case, even though this case has been widely reported and I acknowledge the Deputy is speaking with the permission of the family involved.

I can stress that since the outset of the pandemic, HIQA has had in place a quality assessment process. All of the designated centres and the children’s residential centres are formally contacted on a regular basis by an inspector of social services to assess how they are coping, the welfare of the residents, any concerns they may have and any deficits identified in continuous high quality care. HIQA, as the regulator, has also completed a risk assessment of all nursing homes. It has not been able to inspect all nursing homes but it has completed the risk assessment. On 6 April, it commenced focused Covid-19 infection prevention and control hub to provide nursing homes with the guidance and support they need.

In answer to the Deputy’s direct question as to timelines, I will find out that information for the Deputy. As it was not part of the question, I do not have the information to hand but I will find out that information for the Deputy.

The other matter worth mentioning is that as the Deputy is aware, an expert group will report to me very shortly on the nursing homes. It is looking at what happened across the system. We all will be interested in what happened. What I am most interested in for now is what learnings there will be to ensure that everybody in those nursing homes, both those who work in them and the residents, is safe and secure. I will continue to work with the Deputy on this issue and will keep him up to date on how it is all going.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister. That concludes the debate. The Dáil now stands adjourned until 10.30 a.m. tomorrow in the Convention Centre. Gabhaim buíochas libh.