Thursday, 15 July 2021
Saincheisteanna Tráthúla - Topical Issue Debate
The next matter is from Deputy Tóibín, who wishes to discuss the practice of discharging patients from hospitals into nursing homes during the start of the Covid-19 pandemic. Having put a stop to his gallop on this particular matter the other evening, I am happy to see we have been able to select it today.
Yesterday, under freedom of information, FOI, a document was released to me from the National Treatment Purchase Fund, NTPF. The document was an email, which was issued to nursing homes by the contract manager of the NTPF shortly before 10 a.m. on 12 March 2020. I have already furnished the Minister of State at the Department of Health, Deputy Mary Butler, with a copy of this email, which states that the NTPF had been asked to establish capacity within the nursing home sector. It goes on to state that nursing homes will need: "...to have the ability to care for patients coming from [the] acute hospital setting..." and further states:
Facilities must be able to facilitate short term residents being discharged from [an] acute hospital. ...residents...may be nominated by the HSE [and] the Department of Health as applicable for receipt of appropriate funding.
Describing what will happen, the letter states that the individual facility would co-ordinate directly with the discharge unit within the hospital.
This is a damning document. In many ways, it is a smoking gun. We know that the Covid-19 nursing home expert panel found that 10,000 patients were discharged from hospitals into nursing homes in the first six months of 2020. Was it a Government decision to move elderly patients, wholesale, out of hospital beds and cram them into nursing homes? The major question is who instructed the NTPF to issue this email? The email states that nursing homes were asked to establish capacity. Who asked them? That is the first question.
We have also learned a pot of money was offered to nursing homes at this time. How much was offered to get older people out of hospitals? The context of this discussion is pivotal. In early March, nursing homes voluntarily closed their doors to visitors in an attempt to protect vulnerable residents. On 10 March, Dr. Holohan, the Chief Medical Officer, CMO, issued a statement stating that these restrictions were not necessary. This document shows that two days after telling nursing homes to reopen their doors, an email was issued to nursing homes instructing them to make way for a large influx of patients from hospitals. Further FOI documents released reveal that, throughout all of this, the Minister for Health at the time, Deputy Simon Harris, repeatedly ignored requests for meetings from the chief executive officer, CEO, of Nursing Homes Ireland, Tadhg Daly.
The Fianna Fáil Opposition spokesperson at the time was the Minister, Deputy Stephen Donnelly, and he revealed that the HSE "intercepted" supplies of oxygen, personal protective equipment, PPE, and staff that were meant for nursing homes. Was there a concerted effort by the Government or the HSE to take older people out of the safety of hospitals and cram them into nursing homes during the pandemic? How could this decision be made when the Minister in charge was ignoring appeals from the sector to meet with him, when nursing homes were having their PPE, oxygen and staff taken from them by the HSE and when the CMO was telling nursing homes to keep their doors wide open to the public?
These were an incredible set of events at a period when there was an influx of Covid-19 in this country. It should be remembered, in all the conversations we have had about Covid, the majority of people who died with Covid were in a nursing home or hospital, two locations owned, or under the regulation of, this Government. Can the Minister answer these questions?
The Minister of State, Deputy Butler, was due to take this question today but due to the change of time for Topical Issues, she cannot do so as she is bringing legislation through the Seanad. She sends her apologies for not being in the Chamber for this debate.
The Covid-19 pandemic has led to an unprecedented challenge across our health services and none more so than in our nursing homes. The National Public Health Emergency Team, 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. Quality care and patient safety is a priority and our continued focus is, and will always be, to deliver safe and high-quality services. From the start of the pandemic, the HSE, through the Health Protection Surveillance Centre, has developed an extensive body of guidance and support tools to assist in the management of Covid-19 cases, including in relation to decisions on transfer of patients and residents between care facilities, where appropriate.
The decision to discharge patients from hospitals to nursing home settings is always subject to clinical assessment. Discharges to nursing homes and other settings are a regular, daily feature of a functioning health system. The period from early March 2020 to mid-April 2020 saw an increase in the number of such discharged patients as the health system prepared itself for an expected surge in Covid-19 cases. From an older person's perspective, being admitted for longer than necessary increases the risk of a patient contracting a healthcare associated infection or deconditioning. The vast majority of these discharges took place from 10 March 2020 onwards, when clear public health guidance was in place across all acute hospitals.
On 10 March 2020, the HSE issued interim guidance on transfer between care facilities, which included preliminary guidance on the transfer of hospitalised patients from an acute hospital to a residential care facility in the context of the pandemic. This guidance was circulated to all acute hospitals, community healthcare organisations and residential care facilities accepting admissions of residents. In order to ensure sufficient acute hospital capacity to manage the anticipated surge in hospitals, emergency funding was made available to ensure patients who were clinically stable and appropriate for transfer could have their discharge facilitated, while adhering to the guidance.
There was also an emphasis on ensuring that those patients who had completed their acute medical treatment should be prioritised for such transfers, either to residential care or with some home support, so as to avoid their exposure to the anticipated surge and prevent hospital-acquired Covid-19. The protocols set out in the guidance, along with infection prevention and control advice and supports, were put in place to assist the nursing home sector, with a view to mitigating the level of risk and transfer of Covid-19.
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 Covid-19 and our response to it, to ensure that the positive gains now being experienced are preserved and that those most vulnerable to the virus continue to be safeguarded in the light of residual risk. The Department is continuing to look at options that may be available to the State in listening 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 this difficult time.
In fairness, none of the questions I asked about accountability have been addressed by the Minister of State whatsoever. This is a serious problem. We need clarification with regard to who is behind these decisions. She mentioned that HSE support was provided to the nursing homes. That is not exactly true. Further freedom of information documents I have received show that on 19 October 2020, the Minister of State with responsibility for older persons and mental health, Deputy Mary Butler, wrote to the chief executive of the HSE, Mr. Paul Reid, seeking assurances that the HSE would continue to provide staffing support to homes. Paul Reid did not respond to the Minister of State for a month. When he did, he said that all was well and that the HSE would continue to provide funding for nursing home staffing and support for nursing homes. On 16 October 2020, a similar letter was sent to Mr. Phelim Quinn, the chief executive of HIQA. Paul Reid said he was disappointed that Mr. Quinn stated certain private nursing homes had not reported that they have received support from the HSE.
When Mr. Reid was telling HIQA and the Minister of State that all was well, I had people from nursing homes on the telephone to me crying for staff. I have in mind specifically a case in the Minister of State, Deputy Naughton's, county, Galway. It occurred almost at the same time that these letters were issued. All staff in a nursing home, bar two, tested positive and it was left without any support. This resulted in the two staff who had tested negative being unable to leave the nursing home because there were no replacement staff. That is an incredible situation. In case the Minister of State did not notice, the headlines in the newspapers at the time were screaming about staff shortages in nursing homes. All the while there were 75,000 people who had applied to Be On Call for Ireland but they were pretty much left untouched.
The Minister of State mentioned people being discharged under normal regulations. People were being discharged from these hospitals into nursing homes without being tested. It was an incredible situation. When will there be a full investigation? When will there be accountability? When can we be sure this will not happen again?
The pandemic has been a particularly difficult time for all residents, relatives and staff of our nursing homes. As the House will be aware, the Covid-19 nursing home expert panel established last year provided a comprehensive report and package of recommendations in respect of the ongoing response to Covid-19 and longer-term strategic reform of the care of older persons. Many of the short and medium-term recommendations of the Covid-19 nursing home expert panel report have been implemented. Several of these relate to the delivery of a broad suite of supports provided to private nursing homes, including free personal protective equipment, 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 those recommendations. There has been significant and ongoing consideration of the impact of the pandemic. There have been various examinations and reports with a focus on Covid-19, its impact on nursing homes and the pandemic learnings that can inform future policy, regulation and the model of care for older people.
There has been a clear national commitment to continue to learn from the pandemic as the national and international understanding of the virus evolves. Where necessary we will 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. I look forward to supporting the significant work that is in train to further improve services for older persons.