Johnny Mythen (Wexford, Sinn Fein)
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1850. To ask the Minister for Health the actions that have been taken and the legislative and policy work that is complete and currently underway with regard to the agreed calls of the motion on long-term residential care facilities debated and agreed by Dáil Éireann on 13 July 2021; and if he will make a statement on the matter. [2113/22]

Mary Butler (Waterford, Fianna Fail)
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There has been significant and ongoing consideration of the impact of COVID-19 and the evolution of the response to it, since the start of the pandemic. Various examinations and development of 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 persons have been undertaken. There has 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 independent COVID-19 Nursing Homes Expert Panel was established, on foot of a NPHET recommendation, to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort in nursing homes. This Expert Panel report has added further to our knowledge and learning. This report clearly outlines the key protective measures that we must ensure are in place across our nursing homes. These actions are based on learning from our own and the international experience of COVID-19 to date. The report also recommends additional analysis and examination of the relevant public health and other data sets in order that further causal and protective factors for COVID-19 clusters are identified. HIQA and the Health Protection Surveillance Centre (HPSC) jointly published an “Analysis of factors associated with outbreaks of SARS-CoV-2 in nursing homes in Ireland”, delivering on recommendation 6.7 of the Expert Panel report, to further the learning from the pandemic. Further data analysis work and learning will also continue, in line with other recommendations of the Expert Panel and HIQA and the HPSC are developing a further update to this analysis.

Funding of €17.6 million was secured in Budget 2022 to support the implementation of recommendations in the Expert Panel report. Work to progress these, particularly those recommendations requiring a priority focus in the response to COVID-19, is ongoing across all of the health agencies and stakeholders. Continued learning and understanding of progression of the disease in Ireland is an integral part of those recommendations.

Findings of these reports, including the Expert Panel’s confirm that the very infectious nature of COVID-19 makes it difficult to prevent and control in residential care settings. The reports produced nationally identify findings consistent with international evidence, which have highlighted that the probability of COVID-19 introduction into nursing home depends on the levels of the disease circulating in the community, with a higher risk associated with higher incidence rates in the community.

The Government and the relevant agencies continue to have a priority focus on managing the response to COVID-19, especially in respect of nursing homes. As you are aware the booster vaccination programme is continuing its successful rollout and nursing home residents were prioritised for boosters. The prevalence of the more transmissible Omicron variant has rapidly increased in Ireland and this poses an ongoing risk. 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 been experienced are preserved, and that those most vulnerable to the virus continue to be safeguarded, having regard to the residual risk.

Visiting Guidance

Nursing home providers are ultimately responsible for the safe care of their residents. In a broad sense, visits to nursing homes are governed by legislation under the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013; regulation 11 provides that the nursing home should facilitate visiting and not restrict visiting except in circumstances such as the resident requesting same, or potential risk posed from visiting – this aligns with the risk assessments referred to in the visiting guidance.  The regulations also require that the nursing home has suitable facilities in place and available for residents to receive visits. It is the legal responsibility of each provider to assess the risks and mitigation measures associated with their service and how best to manage visits having regards to the specific circumstances that arise in relation to their service. The HPSC has developed public health guidance, mentioned above, to assist and support providers in this regard. The guidance is kept under continuing review as new evidence and data emerges.

Adult Safeguarding

The Government takes adult safeguarding and matters and allegations of suspected neglect and abuse in health settings very seriously. Safeguarding adults at risk of abuse and harm by others in the context of their interactions with the health sector is a key objective of my Department, every statutory body under its aegis, and every health and social care service that interacts with such adults. The Department of Health is at an advanced stage of developing an overarching national policy on adult safeguarding in the health and social care sector, which will apply to all public, voluntary, and private healthcare and social care settings and agencies under the Department’s remit, including on such matters as appropriate powers, functions, accountability structures and reporting arrangements.  The issue of appropriate powers of entry to health and social care settings for adult safeguarding purposes is among the key issues under consideration in formulating the national health sector policy. 

The Department is preparing to undertake public consultation on this sectoral policy and aims to submit a costed draft policy to Government for its approval in the first half of this year. Legislation as required to underpin the policy will be prepared following its approval by Government. 

Consideration of any proposals for wider national structures, such as a national adult safeguarding authority, would be a matter for consideration across all sectors and Departments and for decision by the Government. Separately, the Law Reform Commission is undertaking a review on A Regulatory Framework for Adult Safeguarding (across all sectors). Upon completion, this Department will consider any recommendations the Commission may make regarding legislation relevant to its functions and anticipates that other Departments will do the same.

The Expert Panel recommended reform of the oversight and governance of safeguarding concerns that occur within private nursing homes. Ensuring the safety of service users is a priority for me. I secured funding in Budget 2022 to support the establishment of 9 permanent Community Support Teams (CSTs) in 2022. As part of this, funding has been allocated for the appointment to each of the 9 CSTs a Social Work Team Leader and a Social Worker. These new resources will enhance the HSE’s Safeguarding and Protection Teams in each CHO and will be assigned to work with the new CSTs, having a particular focus on non-HSE residential care services.

HIQA Regulatory Reform

The primary responsibility for the provision of safe care and service to nursing home residents rests with individual nursing home operators. Registered providers must provide appropriate medical and health care, including a high standard of evidence-based nursing care in accordance with professional guidelines.

Having regard to the “COVID-19 Nursing Home Expert Panel: “Examination of Measures to 2021 and the HIQA’s paper on “The Need for Regulatory Reform” and learning from the pandemic, I have approved a two-phased approach to examining the legislation with a view to proposing enhancements to the primary and secondary legislation governing nursing homes.

Phase 1 will bring forward interim enhancements to the primary legislative framework to enhance governance and oversight of nursing homes. The proposals will, amongst other things: provide new and enhanced enforcement powers for the Chief Inspector; reduce timelines and processes for regulatory actions; and introduce a new reporting system for the reporting and publication of key operational data to support national planning in an integrated way and improve the information available.

The Government is committed to the reform of the regulatory framework governing nursing homes and approved the inclusion of a Health (Amendment) Bill on its legislative agenda. It is expected that, subject to Government approval, a draft General Scheme will be published in the first half of 2022, with a Bill being developed and published thereafter. A bilateral project group comprising representatives from the Department and HIQA, is supporting the legislative process.

A wider review of the regulatory framework, phase 2, will commence in the second half of 2022, taking into account a programme of longer-term strategic reform considerations arising from inter alia pandemic learning.

Johnny Mythen (Wexford, Sinn Fein)
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1851. To ask the Minister for Health if long-term residential care facility visitation guidance has been placed on a statutory footing; the enforcement measures that are in place on same; and if he will make a statement on the matter. [2114/22]

Mary Butler (Waterford, Fianna Fail)
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The Health Protection Surveillance Centre (HPSC) provides a suite of public health guidance including in relation to visiting to long-term residential care facilities, which is reviewed and updated regularly. The HPSC has published updated guidance on visiting in long-term residential care: COVID-19: Normalising Visiting in Long Term Residential Care Facilities (LTRCFs). The most recent version came into effect on 10 January 2022.

The guidance emphasises the need to ensure visiting policy is based on risk assessment, which should take into account, among other things, the overall care needs, rights and wishes of residents, the level of vaccination of residents in the nursing home, the current incidence of COVID-19 in the surrounding community and the capacity of the nursing home to manage risks associated with visiting.

Nursing home providers are ultimately responsible for the safe care of their residents. In a broad sense, visits to nursing homes are governed by legislation under the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013; regulation 11 provides that the nursing home should facilitate visiting and not restrict visiting except in circumstances such as the resident requesting same, or potential risk posed from visiting – this aligns with the risk assessments referred to in the visiting guidance. The regulations also require that the nursing home has suitable facilities in place and available for residents to receive visits. It is the legal responsibility of each provider to assess the risks and mitigation measures associated with their service and how best to manage visits having regards to the specific circumstances that arise in relation to their service. The HPSC has developed public health guidance, mentioned above, to assist and support providers in this regard. The independent regulator, the Chief Inspector, HIQA, monitors compliance with the legal framework in the context of her ongoing regulatory role.

Risks continue to remain and emergent risks such as variants of concern present ongoing challenges and the need for vigilance. Visiting arrangements should continue to take account of general public health advice and the necessary infection prevention and control measures, to reduce the risk of introduction and spread of COVID-19 and protect those living in our communities. This is particularly important in the context of the prevalence of the more transmissible Omicron variant.

Visitors are reminded of their responsibilities with regard to self-checks for COVID-19 in advance of visits, infection and prevention control and social interaction with all individuals, while in the nursing home.