Bríd Smith (Dublin South Central, People Before Profit Alliance)
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784. To ask the Minister for Health when the change to the presence on-site of a gerontologist and a registered nurse took place; the person or body responsible for the change in regulations relating to the care of the elderly in long-term residential care identified by the expert panel report on page 96; and if he will make a statement on the matter. [26368/20]

Mary Butler (Waterford, Fianna Fail)
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The Health Act, 2007 provides for an independent inspection and registration system for residential services.  On 1 July 2009 Statutory responsibility was given to the Chief Inspector of Social Services, part of the Health Information and Quality Authority for inspecting and registering designated centres for older people.  This responsibility was underpinned by a comprehensive quality framework comprising the Health Act 2007, the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009, as amended, the Health Act 2007 (Registration of Designated Centres for Older People) Regulations 2009 and the National Quality Standards for Residential Care Settings for Older People in Ireland. 

The Care and Welfare Regulations were first introduced in 2009, these regulations were extensively reviewed, and revised regulations were published in 2013 to improve the regulatory framework. The new regulations came into effect on 1 July 2014.   

The 2013 Regulations retained the requirement for the person in charge to be a nurse with a minimum of three years’ experience in the area of nursing of older persons within the previous six years and that in certain circumstances the person in charge can be a registered doctor.  The 2013 regulations also provided that from 1 July 2017 any registered nurse appointed to the role of person in charge of a designated centre for older people also needs at least three years’ experience in a management capacity in the health and social care area and a post-registration management qualification in health or a related field.  

Under the Regulations the registered provider is required to ensure that the number and skill mix of staff is appropriate having regard to the needs of the residents, assessed in accordance with Regulation 5, and the size and layout of the designated centre concerned. The person in charge is required to ensure that there be at least one registered nurse on duty at all times, except in circumstances where the Chief Inspector is satisfied that no resident of the designated centre concerned has been assessed as requiring full time nursing care.

Under the Health Act 2007 the Health Information and Quality Authority sets standards on quality and safety.  The National Standards set out what is expected in terms of the service provided to residents, with a focus on continuous development of safe and effective care.  Since the publication of the first National Quality Standards for Residential Care Settings for Older People in Ireland in 2009, the Authority has devised a framework for developing standards which was developed following a review of international and national evidence, engagement with international and national experts and applying the Authority’s knowledge and experience of the Irish health and social care context.  Delivering improvements within quality themes depends on services having capability and capacity in four key areas, one of which is in relation to a Responsive Workforce – planning, recruiting, managing and organising staff with  the necessary numbers, skills and competencies to respond to the needs and preferences of people in residential services.  The Standards are outcome-based. The standard statement describes the high-level outcome required to deliver quality residential services and residential respite services for people.  Under each standard statement there are a list of features which give some examples of what the residential service may consider in order to meet the standard and achieve the required outcome.  

The Standards provide that safe and effective recruitment practices are in place to recruit staff,  staff have the required competencies to manage and deliver person-centred, effective and safe services to all residents, staff are supported and supervised to carry out their duties to protect and promote the care and welfare of all residents and that training is provided to staff to improve outcomes for all residents.