I propose to take Questions Nos. 665 and 702 together.
My Department has continuous and ongoing engagement with HIQA, which since 2009, is the independent statutory authority responsible for regulating residential care services for older people, whether delivered in a nursing home managed by the HSE or a private provider. Services are only allowed to operate if they are registered with HIQA and they are inspected regularly to ensure that they maintain a high level of care. HIQA has significant and wide-ranging powers, up to and including, the cancellation of the registration of a nursing home, where it has significant concerns about the quality of governance and oversight in such services.
My Department engages with HIQA on a regular and ongoing basis on a range of matters related to the provision of high-quality and safe care for people using our health and social care services in Ireland, including the regulatory framework. My Department and HIQA share the view that moving the current national regulatory framework towards a ‘service provider’ model of regulation is an issue which should be examined and progressed over time. This approach is being actively planned for in the context of the forthcoming statutory homecare scheme.
In addition, my Department continues to progress work on the Patient Safety (Licensing) Bill which will, for the first time introduce a licensing requirement for all hospitals, public and private, and certain designated high-risk activities in the community. The drafting of this Bill is on the Government’s legislative programme, the general scheme of the Bill having been approved by Government and subject to Pre-Legislative Scrutiny at the Oireachtas Joint Committee of Health.
Regulation and accountability are not contingent on a commissioning model, since the latter is generally associated with a purchaser/provider split which is a feature of health reforms in some countries, but which is not universal by any means and is subject to ongoing health policy debate.
On 29 and 30 of March 2020, key officials from the Department, HIQA, HPSC and HSE met to discuss nursing homes. It was agreed that representatives from the Department, HIQA, HSE and HSPC would collaborate to prepare a paper, encompassing a framework of necessary information, for consideration by the NPHET at its meeting of 31 March on the specific issues and risks relating to COVID-19 infections in residential healthcare facilities. To inform the development of the paper, HIQA provided an information framework document to the team on March 30. A variety of potential risks were identified. These included the risk of small providers, access to infection prevention and control (IPC) advice, access to PPE and timely access to testing. Following consideration of the paper referred to at the above NPHET meeting of 31 March, NPHET requested HIQA to risk assess all nursing homes and liaise with relevant national and regional governance structures as necessary in light of mitigating actions. This was part of an overall package of public health measures recommended following this meeting.
The risk assessment, amongst other things, outlined that the private nursing home sector has no clinical governance oversight by or relationship with the Health Service Executive. It should be noted that registered providers must provide appropriate medical and health care, including a high standard of evidence-based nursing care in accordance with professional guidelines. Furthermore, regulations provide that a nursing home must have a person in charge. In cases where the person in charge is also the registered provider, that person may be a registered medical practitioner with required experience. Where the registered provider is not the person in charge, the person in charge must be a registered nurse with the required qualifications and experience.
Notwithstanding the fact that the primary legal responsibility lies with individual providers, as recommended by NPHET on 31 March 2020, the HSE has further strengthened its National and Regional Governance Structures to support the response of nursing homes to COVID-19. The HSE has established 23 COVID-19 response teams at CHO level, which are providing nursing homes with medical, nursing, staffing and other supports. The teams are composed of consultant geriatricians, clinicians, infection prevention control experts and senior nurses.
Finally, on foot of a NPHET recommendation, on 23 May 2020, I established a COVID-19 Expert Panel on Nursing Homes. The purpose of the Panel is to examine the national and international responses to COVID-19 and provide immediate real-time learnings and recommendations in light of the expected ongoing impact of COVID-19 over the next 12-18 months.