Dáil Éireann Debate, Wednesday - 27 January 2021
708. Deputy Gino Kenny asked the Minister for Health the status of the private nursing home sector with particular reference to staffing levels, financial viability and supports being offered to the sector; and if he will make a statement on the matter. [3792/21]
View answer710. Deputy Gino Kenny asked the Minister for Health his plans in the event of the closure of either private or public nursing home facilities; and if he will make a statement on the matter. [3794/21]
View answer711. Deputy Gino Kenny asked the Minister for Health if a copy of contingency plans he may have for various adverse scenarios affecting private nursing homes will be provided; if a summary will be provided of these plans with particular reference to crises in staffing and in the event of serious Covid-19 outbreaks; and if he will make a statement on the matter. [3795/21]
View answer712. Deputy Gino Kenny asked the Minister for Health if he has examined the option of emergency State intervention or State control of private nursing homes; if so, if costings for the acquisition and or operation of private facilities are available; and if he will make a statement on the matter. [3796/21]
View answerI propose to take Questions Nos. 708, 710, 711 and 712 together.
The Nursing Homes Expert Panel report, published in August 2020, made 86 recommendations on a range of issues, including in relation to ensuring that safe staffing is available in nursing homes, that staff should not work across multiple sites, that infection prevention and control measures are in place and that PPE is readily available and utilised appropriately. The Department continues to engage, including through the Implementation Oversight Team and the Reference Group with the HSE as a nursing home provider and with the representative body for private and voluntary nursing homes, on the implementation of the recommendations of the Nursing Homes Expert Panel report.
As you are aware, the epidemiological situation in relation to COVID-19 has deteriorated, including in relation to nursing homes. Preliminary data from the Health Protection Surveillance Centre (HPSC) indicates that there are over 180 open outbreaks, which is over 5 times the amount of nursing home outbreaks open in mid-December. As noted by the Expert Panel and the European Centre for Disease Control (ECDC), where there are high rates of community transmission, the risk to nursing homes is high. The HSE indicates that the recent changes in the incidence of COVID-19 nationally and, in particular, in nursing homes have presented significant staffing challenges across healthcare settings. The HSE is indicating that over 1,800 nursing home staff are presently absent as a result of COVID-19. As you will appreciate, this is placing significant challenges on nursing homes. The HSE and HIQA are activating all of the available and established supports; however, staffing, particularly nursing staff, remains a particular challenge .
The established serial testing programme for nursing home staff remains a key support mechanism and is now in its seventh cycle. The testing programme is a critical part of the ongoing response to COVID-19 in nursing homes and allows for the early detection of cases and targeting of the early intervention of COVID-19 Response and Outbreak Control Teams. Over the coming weeks, where appropriate, the frequency of testing will be temporarily increased to a weekly basis under the guidance and advice of the relevant local HSE teams in agreement with nursing homes.
Additionally, the comprehensive range of public health and infection prevention and control advice remains to be of critical importance, including the appropriate use of PPE. The HSE and HIQA has developed and delivered comprehensive training resources and webinars for staff in relation to these matters.
The State’s responsibility to respond to the public health emergency created the need for the HSE to set up a structured support system in line with NPHET recommendations. This has been a critical intervention in supporting the resilience of the sector in meeting the unprecedented challenges associated with COVID-19.
These supports remain in place and have encompassed:
- Enhanced HSE engagement
- Temporary HSE governance arrangements
- Multidisciplinary clinical supports at CHO level through 23 COVID-19 Response Teams
- Access to supply lines for PPE, medical oxygen etc
- Serial testing in nursing homes
- Access to staff from community and acute hospitals
- Suite of focused guidance, including comprehensive guidance on visiting nursing homes
- HIQA COVID-19 quality assurance regulatory framework
The Temporary Assistance Payment Scheme which provides additional funding to private and voluntary nursing homes that require it has been extended until the end of June 2021. Given the importance of facilitating safe visiting over the winter period, it was decided to expand the eligibility criteria under TAPS on a once-off basis to allow a claim of up to €2,500 per eligible nursing home as a contribution towards the cost of visiting infrastructure. This was intended to support nursing homes in creating additional safe visiting spaces and enhancing current visiting spaces. As of 21 January, there have been 4,845 claims processed, with total payments of over €63.6m of direct financial support provided to the sector.
Since 2009 the Health Information and Quality Authority, HIQA, is the statutory independent regulator in place for the nursing home sector, whether a HSE managed or a private nursing home. The functions and powers of the Chief Inspector are set out in Parts 7, 8 and 9 of the Health Act 2007 (as amended). The Statutory powers include the cancellation of registration under section 51 of the Act and the urgent action under section 59 of the Act to attach, vary or remove a condition of registration or cancellation of registration.
In the first instance, the primary responsibility for the provision of safe care and service to nursing home residents’ rests with individual nursing home operators. If the Chief Inspector cancels a registration under section 51 and the cancellation takes effect, or if the Chief Inspector obtains an order to cancel a registration in accordance with section 59 and the cancellation takes effect then under section 64 of the Act the Chief Inspector notifies the HSE of the cancellation of the registration and of the date on which this takes effect. The HSE must make alternative arrangements, as soon as practicable for residents where registration has been cancelled and closure orders have been secured by HIQA. Pending these alternative arrangements, the HSE, either with the consent of the registered provider or by order of the District Court shall take charge of the designated centre.
The first stage of the Covid-19 Vaccine Programme commenced on 29th December in hospital settings with the aim of moving quickly to commence vaccinations in nursing homes spread across the country with an estimated 29,000 residents and c.41,000 staff. Last week, the HSE completed roll out of the first vaccine dose to the majority of residents and staff in nursing homes. Due to outbreaks of Covid-19, a very small number of facilities were not included in this first series of vaccinations on public health advice, while, in a significant number, not all residents or staff could be included in the vaccination programme due to their Covid status. Those residents and staff who were unable to receive a first dose will be included once deemed safe to do so. This week, roll out of the second vaccine dose will begin in 27 nursing homes.
As a number of the issues raised by the Deputy are service matters I have asked the HSE to respond directly to the Deputy as soon as possible.
