Tuesday, 6 July 2021
Saincheisteanna Tráthúla - Topical Issue Debate
I welcome the Minister of State, Deputy Butler, to the House. As we are all aware, more than 2,000 people have died in our nursing homes due to Covid over the past 12 months or so, 1,000 of them, sadly, in the third wave. What is special about Dealgan House is that 23 residents died from Covid there in April 2020 and it is the only nursing home in the country, notwithstanding all the deaths elsewhere, that was taken over by the HSE. A serious, significant administrative decision was made to go in there and take it over, and the families want to know why that happened. On 5 April they expressed serious concerns about the nursing home. On 11 April, Paul Reid, the head of the HSE, was made personally aware of the unfolding tragedy. It took until 17 April for substantial supports to be in place in the nursing home.
The families want to know what happened in the meantime. They are entitled to know that, they are entitled to closure. The families met have met, with due courtesy, with the Minister and Minister of State, Deputies Donnelly and Butler. They met the head of the RSCI Hospital Group, Ian Carter. We have put in dozens of parliamentary questions. They have put in dozens of freedom of information requests. The families who suffered most are still waiting on the truth. The only way they will get that truth, I believe, is through a commission of inquiry. There is a precedent for that, namely Leas Cross. It was the only nursing home taken over by the HSE. The Minister can make the order and the Dáil will approve it. There can be voluntary co-operation of witnesses, power of search, and compellabillity of witnesses is needed under fair procedures. I know two witnesses who want to give evidence to such an inquiry who were shocked and appalled by what they found in the home when they went in there. They are ready, willing and able to come before such an inquiry. I ask the Minister of State to address that significant failure of management in that nursing home in her reply. The only way that truth will out is by such an inquiry, transparent, open and accountable.
The Minister of State and the Minister met these families. The Minister said that a mechanism was needed for these families to be able to get to the truth. I reiterate what Deputy O'Dowd has said. We need to lay out what these families have done through their freedom of information requests, the parliamentary questions we have tabled and through a great deal of interaction, negotiation and questioning of all the bodies from the HSE, CHO 8 and the RCSI Hospital Group. A huge amount of information is in the public domain. Ultimately, a tragedy occurred in Dealgan House nursing home with 23 deaths. It was a nursing home that the RSCI Hospital Group took under operational control because that was regarded as necessary. There is a disputed narrative. A mechanism is the only way we will get to the bottom of what happened and to learn what we need to learn to ensure this never happens again. Unfortunately there have been a number of these cases. The families need that mechanism. I am not particularly worried about the means. Deputy O'Dowd spoke of a commission of investigation but whatever means are necessary need to be used. There needs to be engagement with the families on the type of investigation and it must be one that will provide all the answers. We cannot have this situation continue on and on. The families have been very good. They accepted there were issues in December and January and following the ransomware attack but this needs to happen as soon as possible.
I thank Deputies O'Dowd and Ó Murchú for raising this, and it is not the first time they have done so with me both on the floor of the Dáil and in person. The Covid-19 pandemic has led to an unprecedented challenge across our health services and none more so than in our nursing homes. I think it is fair to say that the health and safety of residents in nursing homes has been paramount in all our minds over the past 16 months especially. The National Public Health Emergency Team, NPHET, the Department, the HSE and the Health Information and Quality Authority, HIQA, placed a focus on supporting older people in nursing homes throughout the pandemic.
Every person who is supported in older persons services is entitled to expect and receive supports of the highest standard. Quality care and patient safety is a priority and our continued focus is and will always be to deliver safe, high quality services. The safety and protection of older people is a priority for the Government.
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 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. This responslbility 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, including site inspections, whether a nursing homes 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 discretion in deciding whether to impose conditions of registration on nursing homes.
During the response to Covid-19, nursing homes continue to be regulated by HIQA which, under the Health Act 2007, has the legal authority to examine the operation of any facility under its remit. HIQA undertook inspections of this nursing home both in May and September 2020. The reports of these inspections were published in late 2020. The May report notes that HIQA was satisfied to re-register the centre with several improvement-focused conditions including some on individual assessment and care planning. In its role as regulator, HIQA will continue to inspect individual nursing homes. For the purposes of providing additional supports, and as a once-off measure, the Department requested that the patient advocacy service extend its service to Dealgan House Nursing Home in order to support families during this time. This service continues to support residents with complaints relating to issues experienced during March to August 2020 and to support families of residents who sadly died during that period.
It must be recognised that the pandemic has not concluded and at this time a priority focus of Government remains on the ongoing management of the Covid-19 response to ensure that the positive gains now being experienced are preserved and that those most vulnerable to the virus continue to be safeguarded in light of the residual risk.
I am very aware that listening to families can bring great learning to many situations. While we are still dealing with a degree of risk in nursing homes due to Covid-19, we are continuing to look at options which may be available to the State in listening to the voices of those who have lost a loved one. I would like to conclude by expressing my condolences to those who have lost a loved one during this period.
I am very disappointed by the Minister of State's response. I am offended by her comment that the pandemic has not concluded. It has concluded for these families; their family members are dead. The home was taken over by the HSE. There are serious questions about the management of the home. The Minister of State knows that as does the HSE and the hospital group. This week, Dr. Sarah Donnelley wrote in The Irish Times:"Now is the time for a comprehensive public inquiry involving a root-and-branch review and reform of our nursing home sector, based on human rights principles." There was a critical failure of management in this nursing home. I have absolutely no doubt about it and lots of other people know that too. We cannot hide behind this speech. I have to say I am deeply unhappy and I cannot accept what the Minister of State is putting before us this evening. It is a whitewash. It is unacceptable. It is insulting, most of all to those families who have fought tooth and nail. They have had no closure and will not get it until there is a fair inquiry into the failure of management, into the weak policy of legislation and the weak regulation. We do not have confidence in HIQA. We know what it did. I can give chapter and verse on that. It does not investigate individual complaints. The Minister of State and I both know that; everyone knows that. This will continue until we have the inquiry and I will continue to raise it here and insist that we do our job as a Government. I support the Minister of State and this Government. She has to do her job and I will insist that she do it. It must be done for truth and confidence in the system as we go forward.
A public inquiry is the only thing that will give an answer to these families who deserve it. I think everyone accepts that. We need that timeline and then to look at mechanisms. The onus is on the Minister of State and the Minister, Deputy Donnelly, to go back to those families and give them that mechanism. We cannot continue as we are. If there are logistical reasons it cannot happen now, and I cannot see that it cannot, we need to give the families a timeline. That is fair. There are questions to be answered by the nursing home but also by the HSE, by HIQA and the RCSI Hospital Group. HIQA has put it on the record many times that it would accept its own weaknesses as a regulatory body and that it needs greater legislative powers.
We have had a number of reports on nursing homes and elder care, and they have all pointed out the weaknesses. It is not just that we have an insufficient amount of home care and that people are sometimes forced into nursing homes, we must examine the entire issue. In simple terms, we need a timeline and a mechanism and we must deal with the families.
The pandemic has been hugely difficult for all residents of nursing homes, their relatives and staff. Suffering a bereavement is even harder when all the normal rituals have been disrupted. I acknowledge that Covid-19 has had a very challenging and sad impact on the lives of people living in nursing homes, their families and friends.
The Covid-19 nursing home expert panel established last year provided a comprehensive report and package of recommendations on both the ongoing response to Covid-19 and the longer term strategic reform of older persons' care. Many of the short and medium term recommendations of the Covid-19 nursing home expert panel report have already been implemented. A number of those relate to the delivery of a broad suite of supports provided to private nursing homes, including free PPE, serial testing, HSE Covid-19 response teams, infection prevention and control training and temporary accommodation for staff.
Continued learning and understanding of the progression of the disease in Ireland is an integral part of the expert panel's recommendations. There has been a significant and ongoing consideration of the impact of the pandemic, with various examinations and the compilation of reports with a focus on Covid-19, its affect on nursing homes and the learnings that can inform future policy regulation and the model of care for older persons. There has also been a very 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 very infectious nature of Covid-19 makes it difficult to prevent and control in residential care settings. We are continuing to look at options that may be available to the State in the context of listening to the voices of those who have lost loved ones.