That Dáil Éireann shall take note of the Report of the Special Committee on Covid-19 Response entitled 'Special Committee on Covid-19 Response – Final Report', copies of which were laid before Dáil Éireann on 8th October, 2020.
I thank the Business Committee for scheduling a debate on the final report of the Special Committee on Covid-19 Response, which I had the honour of chairing earlier this year. Before commencing with the recommendations, I would like to thank all members of the committee. There were 19 of us who worked through the summer. I see that the Minister of State, Deputy Butler, and the Minister for Health, Deputy Stephen Donnelly, both of whom were members of the committee before they were appointed to office, are present and I thank them. They were replaced on the committee by other Deputies. I thank all of the members of the committee for the courtesy with which we generally carried out our work. It would be wrong to say that there was unanimity on everything - that is not the nature of a committee which has representatives from all parties and all groupings in the House - but there was a unanimity that we would proceed in a collegiate and courteous manner. That was reflected right up to the end, which I, personally, am happy about.
There were a number of recommendations agreed. Obviously, different members of and different political groupings on the committee had a different emphasis with regard to the recommendations but at the end of the day, it was a consensus document. Even the Acting Chairman, Deputy Durkan, who was a member of the committee, would have an emphasis on certain recommendations over others but that is the nature of a committee and we agree a consensus document at the end of it.
There is a tendency in this House - I am sure it is not unique to this Legislature - to have committees look at various issues and then say that they have been examined and we will park them. I think everybody will agree we certainly do not have that luxury with Covid-19. It is the issue which dominates every sector of Irish economy now and will continue to do so for the foreseeable future.
The best way to proceed is to outline in brief the recommendations of the committee. The first recommendation was:
That a public inquiry be established to investigate and report on all circumstances relating to each individual death from Covid-19 in nursing homes. Draft terms of reference should be presented for consideration by the Joint Committee on Health by the end of 2020.
It is obvious that time is ticking in that regard, if we are to proceed in that regard. That is clear to me, and I think it was clear to all committee members. As Chair, one of the more difficult things that I had to do was not to have an emphasis on individual deaths or on individual nursing homes in which there were deaths because clearly there is a huge void in people's lives and they need and deserve answers as to what happened. It was not the role of the committee to look into that in anything like the detail required. Obviously, it was not the role of this committee to make findings of fault with regard to anybody.
It may be the case that there was not fault but equally it may be the case that there was. We, as a Legislature, need to ensure those answers are provided to grieving relatives. Of course, we know a lot more about Covid-19 now than we did then. Any investigation must look at what was known or ought to have been known at the time particular decisions were made. This includes decisions around discharging large numbers of elderly people in particular from acute hospitals into nursing homes. We cannot judge actions by what we now know, only by what was known or ought to have been known at the time.
A second recommendation was that a review should be undertaken into the impact of privatisation on Ireland’s nursing homes to ascertain its impact on nursing levels, expertise and qualifications of staff, medical and other facilities available in older people’s care settings and the adequacy of funding to deliver optimal outcomes. In that regard, it is important that that review take place to see what the impact the of undoubted increase in the size of the private sector has been. It is also important to bear in mind that there were no disproportionate deaths. Each death was tragic; as somebody who lost a relative at the start of this year in a nursing home, thankfully before Covid-19 arrived, I know what the void in one’s life is like. There was no evidence before the committee and it was specifically probed for, of any sort of disproportionality. The proportion of deaths in private nursing homes versus public nursing homes was pretty much the same as the proportion of residents in private nursing homes versus public ones.
The third recommendation was "That the State develop a system of testing and contact tracing with a turnaround time for testing that does not exceed 24 hours, and immediate tracing ... thereafter." I will allow anybody else to speak on this issue because, unfortunately, we as a State have not succeeded in that regard. Contact tracing in particular has been problematic and it was raised repeatedly at the committee. There were three reports released before the final one, one of which was an interim report on testing and tracing that was released just before the summer vacation at the end of July. This issue was highlighted in that report. There was also an interim report on nursing homes which highlighted that we need to move away from a care model of people being cared for in congregated settings and towards a model of caring for people in their communities. Covid-19 has shown up all of the structural weaknesses of society, from problems we have in the education sector with regard to the infrastructure of our schools etc., to the fact that we have an over-reliance on congregated settings. I do not expect that will be solved overnight but policy needs to be oriented in that direction as we move forward.
In parallel there was also an expert group looking at Covid-19 in nursing homes established by the then Minister for Health, Deputy Harris. It produced a report which came up with broadly similar recommendations to those the committee had in its interim report. Indeed, the committee's fourth recommendation was:"That an implementation plan be drawn up for the recommendations contained in the Report of the Covid-19 Nursing Home Expert Panel with a requirement for six-month progress reports to the Houses of the Oireachtas."
There was a further recommendation that the Government make provision for a statutory sick pay scheme to cater for low-paid workers such as those in nursing homes and meat plants, and make Covid-19 notifiable disease. It is important to say that Covid-19 is now a notifiable disease but the first matter is one on which considerable progress remains to be made. I am aware the Government has said it will look towards establishing statutory sick pay by the end of 2021. The Labour Party has been instrumental in pushing that and I thank Deputy Duncan Smith for attending the debate tonight.
There was a recommendation that:
A full review of the regulatory frameworks in respect of HIQA and the HSA should be undertaken and include the adequacy of both the powers of and resources available to each body to carry out reviews. The review should also establish the precise ground under which regulations were removed that required (i) the ‘person in charge’ of a nursing home to have formal gerontology qualification and (ii) the requirement for the presence of a registered nurse on duty at all times ...
A further recommendation we looked at in the interim report was that a medical officer be appointed in respect of each nursing home because there are medical officers in respect of some HSE facilities though not all. It is almost an accident or a curiosity of their history and how they evolved. In some nursing homes there are various residents who are still under the care of their GPs. That GP has a duty of care to his patients but only to them, rather than to the broader community. That is something that is important in the context of a pandemic and may have broader ramifications in treating influenza. Thankfully, the nursing home in which my mother passed away has, to date, avoided Covid-19 but every year a number of patients die of influenza. What we learn from Covid-19 does have repercussions for the treatment of other respiratory ailments.
The seventh recommendation was that "The State should phase out support for facilities where residents do not have adequate self-isolation facilities and it should accelerate the capital works in all publicly owned facilities to ensure that all residents can live in self-contained units." That is an important thing, as is the fact that moneys are paid in respect of new residents in nursing homes which have failed HIQA quality control standards.
There is another recommendation which is very important. It calls for: "An ‘Inquire, Record and Report Inquiry (pursuant to section 7 of the Houses of the Oireachtas (Inquiries, Privileges and Procedures) Act 2013)’..." into the operation of meat processing plants, including "the use of agents to procure workers, to include the State’s response in terms of protecting workers, [and] ensuring necessary food supplies to the general population, as well as ensuring fairness for primary producers". This is because we know that at that time, meat plants were a hotspot of Covid transmission in Ireland, as they were in every other country. It seems we in Ireland have a unique relationship with meat plants, a sort of light touch regime. The Minister for Health may not agree with me but that is certainly my view on it and we need to look at its operation throughout this.
The following recommendation is a very important one, namely, "Data relied upon by NPHET, its modelling code, as well as international evidence relied upon in making its recommendations ... should be published in full and a peer review commissioned." The purpose of this is not to undermine NPHET in any way. However, NPHET is all about science, and we are told that this is all about science but the essence of science, be it the establishment of a vaccine or be it a modelling code, is peer review. The editor of The Lancet came out with a quite interesting tweet regarding some of the very recent developments on vaccines which could herald very good news but until they are peer-reviewed, we do not know.
Those are the main recommendations.