Paul Murphy (Dublin South West, RISE)
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687. To ask the Minister for Health the number of submissions noting concerns that were made to HIQA regarding nursing homes from 2020 to date in 2022, by the type of concern and by county, inclusive of concerns of safeguarding, substandard care, poor communication and visiting. [60914/22]

Mary Butler (Waterford, Fianna Fail)
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As this is a request for information on the volume of services provided by the Health Information and Quality Authority, I have asked HIQA to collate the details sought by the Deputy and I will forward them to him as soon as they are available.

Paul Murphy (Dublin South West, RISE)
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688. To ask the Minister for Health the number of submissions noting concerns that were made to his Department regarding nursing homes from 2020 to date in 2022, by the type of concern and by county, inclusive of concerns of safeguarding, substandard care, poor communication and visiting. [60915/22]

Paul Murphy (Dublin South West, RISE)
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693. To ask the Minister for Health the number of concerns his Department received from staff and families with concerns in nursing homes; and the action that was taken. [60920/22]

Mary Butler (Waterford, Fianna Fail)
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I propose to take Questions Nos. 688 and 693 together.

I recognise how difficult it has been for the families of nursing home residents during this pandemic, which has presented one of the greatest and most wide-ranging public health challenges internationally in recent history. Throughout the pandemic, as part of the overall national response to COVID-19, there has been a specific and sustained focus on older persons, particularly those resident in nursing homes.

The Health Act 2007, as amended, provides the overarching regulatory framework for the nursing home sector with further detailed requirements set out in Registration Regulations, Care and Welfare Regulations and Quality Standards. Under the Health Act 2007, as amended, and related Regulations, the registered provider is responsible and accountable for the quality of care and safety of residents in nursing homes (designated centres) and all nursing homes are required to have a clear complaints procedure in place. Part 10 of the Care and Welfare Regulations sets out the requirements in this regard. The majority of representations to my Department for the period set out by the Deputy, which coincides with the COVID-19 pandemic, were in relation to restrictions on visitation that had been implemented to protect the residents of nursing homes from COVID-19 infection or were in relation to the service provided by the home. Any complaints of a serious nature are forwarded to HIQA as a matter of course and to the HSE where appropriate.

My Department advised that the Health Protection Surveillance Centre (HPSC) provides a suite of public health guidance, including in relation to visiting to long-term residential care facilities. Throughout the pandemic, the guidance was continuously reviewed as new evidence and data emerged. Furthermore, the visitation policy of each nursing home, aside from periods of national restrictions on public opening, are determined by the person-in-charge. The person-in-charge of the nursing home will be able to provide information on the complaints process in place in the nursing home and assistance on how to make a complaint. If a complainant is unhappy with the response received, he or she can appeal the decision as provided for in the Regulations. The complainant may also decide to submit the issue to the Office of the Ombudsman, the Medical Council, the HSE, the Patient Advocacy Service, depending on the circumstances of the case.

Separately, HIQA welcomes information in relation to designated centres that come within its regulatory remit. As a regulator, HIQA has no legal role in examining individual complaints, however, the Authority does take into account all information it receives, including complaints from the public, when carrying out inspections and this range of information informs a risk-based approach to regulation.

Currently my Department is examining complaints processes across the nursing home sector, including information on best practice, the level of standardisation, and the views of key stakeholders, including residents and families, with a view to determining the need to further develop enablers such as policy, legislative and/or guidance instruments to strengthen and enhance current arrangements.

In tandem with this work, the Patient Advocacy Service (PAS), which currently supports residents in HSE-operated nursing homes in making complaints, will begin its rollout to private nursing homes at the end of 2022. This is in line with a Programme for Government commitment to examine extending the remit of the Patient Advocacy Service to residents of long-term residential care facilities.

Paul Murphy (Dublin South West, RISE)
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689. To ask the Minister for Health the number of submissions to note concerns that were made to his Department of the confidential recipient regarding HSE nursing homes from 2020 to date in 2022, by the type of concern and by county, inclusive of concerns regarding safeguarding, substandard care, poor communication, and visiting. [60916/22]

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.

Paul Murphy (Dublin South West, RISE)
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690. To ask the Minister for Health the number of nursing homes that took a case against HIQA to prevent publication of its report since March 2020; and if he will provide the details including the name and county of the homes. [60917/22]

Mary Butler (Waterford, Fianna Fail)
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Proceedings were concluded between HIQA and two nursing home providers during the period set out by the Deputy.  One was an application seeking a judicial review of the regulatory judgements of the Chief Inspector contained in a report, the second was an application seeking leave to challenge certain decisions of the Chief Inspector contained in an inspection report.  A stay on the publication of the relevant reports was granted, pending determination of the proceedings. Both reports are now published.

There is one further proceeding which is still ongoing, and as such it would not be appropriate for me to comment on the matter.

Paul Murphy (Dublin South West, RISE)
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691. To ask the Minister for Health the number of safeguarding referrals that HIQA have forwarded to the guards and to the safeguarding teams from March 2020 to date in 2022. [60918/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Health Information and Quality Authority (HIQA) has advised as follows:

All safeguarding issues are reviewed as a matter of priority to determine the most appropriate regulatory action. In situations where substantiated safeguarding issues are identified, providers are required to take action to ensure the safety of residents. If immediate risks to the safety of residents are identified, providers must take immediate action to address these issues and to prevent a recurrence. The Chief Inspector continues to monitor the actions of the provider to ensure they are effective in addressing the safeguarding concerns. The Chief Inspector can, and has, taken further action, up to and including the cancellation of registration, where providers fail to sustain improvements to residents’ safety.

Since 2020, 10 referrals were made to the HSE National Safeguarding Office and two to An Garda Síochána in relation to safeguarding incidents in registered designated centres.  A further two situations are currently under review with a view to referral to An Garda Síochána.

In addition, a further 10 referrals were made to the HSE National Safeguarding Office and one to An Garda Síochána in relation to safeguarding incidents in services outside of HIQA’s remit.

Paul Murphy (Dublin South West, RISE)
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692. To ask the Minister for Health if he will provide details of the blanket DNR (do not resuscitate) that was put in place in nursing homes in March and April 2020. [60919/22]

Mary Butler (Waterford, Fianna Fail)
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To ensure that Do Not Attempt Resuscitation (DNAR) orders are made consistently, transparently and in line with best practice, the Health Service Executive (HSE) provides guidance regarding advance care planning including making DNAR decisions. The HSE National Consent Policy 2019 – Part 4 Do Not Attempt Resuscitation - provides a decision-making framework that facilitates the advance discussion of personal preferences.

The Department of Health and the 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 Department of Health published an Ethical Framework for Decision Making in a Pandemic in March 2020 which contained a set of ethical principles and procedural values to support and inform policy-makers, health care providers and clinicians in decision-making during the pandemic. Further guidance issued on the delivery and provision of healthcare matters, including Ethical Considerations Relating to Long-Term Residential Care Facilities in the context of COVID-19. This document specifically references blanket policies on DNARs and states – “Blanket policies relating to decisions such as transfer or non-transfer to hospital or Do Not Attempt Resuscitation Orders (DNAR) orders, should a resident become seriously ill due to COVID-19 or any other condition, are inequitable and discriminatory.”

The HSE also published a number of guidance documents to support clinicians. This includes Guidance Regarding Cardiopulmonary Resuscitation and DNAR Decision-Making during the COVID-19 Pandemic published in May 2020. This guidance was applicable to all care environments where services are provided for and on behalf of the HSE including acute hospitals, the ambulance service, community hospitals, residential care settings, general practice and home care. This guidance states - “There should be no discrimination for or against persons who have or are suspected to have COVID-19 in relation to DNAR decisions. Individualised care is at the heart of good clinical practice. The pandemic does not justify any healthcare workers deviating from that approach by making DNAR decisions on a group basis. Such a decision would be contrary to all guidance and human rights principles.”

The purpose of these guidance documents was 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.

Paul Murphy (Dublin South West, RISE)
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694. To ask the Minister for Health the role that the geriatricians on the Covid-19 response teams played in engagement with nursing homes which had outbreaks and in the meetings with specific homes, who made decisions on medication and transfer to hospital for residents. [60921/22]

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.