Paul Murphy (Dublin South West, RISE)
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1564. To ask the Minister for Health if it was a policy decision to obtain anticipatory prescriptions for end-of-life medications for all residents in nursing homes in 2020 and 2021 including for residents who were otherwise healthy. [29738/22]

Paul Murphy (Dublin South West, RISE)
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1565. To ask the Minister for Health the person who made the decision for nursing homes to decide that residents would be denied access to hospital treatment for Covid-19 in 2020 and 2021. [29739/22]

Paul Murphy (Dublin South West, RISE)
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1566. To ask the Minister for Health if nurses in nursing homes were given additional powers above their grade to make decisions regarding the administration of end-of-life medication without a doctor or palliative specialist examining the resident. [29740/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 1564 to 1566, inclusive, together.

The Department of Health and the Health Service Executive (HSE) developed a broad range of national ethical and clinical guidance throughout the course of the COVID-19 pandemic with a view to supporting healthcare workers, managers, and policy makers as they navigated their way through the ethical challenges and difficult decisions they were called upon to make during this challenging time.

The Ethical Framework for Decision Making in a Pandemicand the supporting documents produced by the Department clearly articulate the importance of fairness, inclusiveness, proportionality, and non-discrimination, all of which are enshrined Human Rights principles. Further guidance issued on the delivery and provision of healthcare matters in a pandemic and in long-term residential care services include Ethical Considerations Relating to Long-Term Residential Care Facilities in the context of COVID-19; Preliminary Clinical and Infection Control Guidance for COVID-19 in nurse-led Residential Care Facilities (RCF); and Anticipatory Prescribing in the Last Hours or Days of Life. The purpose of these guidance documents is to support clinicians in their care of patients and service users, including in respect of the making of appropriate clinical decisions. Such decisions, on the provision of healthcare or the transfer to another healthcare facility, are arrived at in consultation between the clinical experts and the resident or his or her representative, and in recognition of the needs and wishes of the resident. This is in line with the relevant guidance which notes that the transfer of residents to hospital is only appropriate where this will confer additional benefit and that decisions to transfer should be made in conjunction with the person, their families and their advanced care plans.

All grades of nursing work within a Scope of Practice Framework, set out by the regulator of the profession (the Nursing and Midwifery Board of Ireland - NMBI). The scope of practice sets out the procedures, actions and processes that the registered nurse is allowed to perform. Scope of practice for nurses and midwives in Ireland is determined by legislation, European Union (EU) directives, international developments, social policy, national and local guidelines, education and the individual practitioner’s levels of competence. There have been many changes and developments in the Irish health service and in nursing and midwifery roles. These include changes in systems of care provision, reforms in professional education and expansion of the scope of nursing and midwifery practice roles to meet patient needs. Factors such as the practice setting and collaborative practice can influence a nurse’s scope of practice.

The prescribing of medicinal products is an expanded role that nurses and midwives undertake following successful completion of an approved education programme and having regard to legislation, professional regulation and national and local health service provider policies, procedures and guidelines. Each registered nurse must prescribe within their scope of practice and is individually accountable to keep up-to-date with advances in medicinal product prescribing and clinical practice and must acknowledge any limitations in their competence. The scope and context of practice should be determined with reference to the Scope of Nursing and Midwifery Practice Framework (NMBI, 2015) and the Practice Standards and Guidelines for Prescriptive Authority (NMBI, 2019) that a registered nurse should adhere to as part of their professional responsibilities. The relevant medicines legislation, associated regulations, national and health service provider policies, procedures and guidelines must inform prescribing practice of the registered nurse. The clinical governance for the prescribing of medicinal products is now determined by the local health service provider.

Finally, nursing home providers have a legal duty to ensure the provision of appropriate medical and health care to residents, and to ensure appropriate care and comfort is provided to a resident approaching the end of his or her life. This is set out in the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013, under Regulations 6 and 13 respectively.

Paul Murphy (Dublin South West, RISE)
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1567. To ask the Minister for Health the amount of temporary assistance payment funding that has being given to nursing homes to date by nursing home or company. [29741/22]

Mary Butler (Waterford, Fianna Fail)
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As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.