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 Authority, established under the Health Act 2007, has significant and wide-ranging powers up to and including withdrawing the registration of a nursing home facility, which means that it can no longer operate as a service provider. This responsibility is underpinned by a comprehensive quality framework comprising of Registration Regulations, Care and Welfare Regulations and National Quality Standards.
HIQA, in discharging its duties determines, through examination of all information available to it, including site inspections, whether a nursing homes meets the regulations in order to achieve and maintain its registration status. Should a nursing home be deemed to be non-compliant with the Regulations and the National Quality Standards, it may either fail to achieve or lose its registration status. In addition, the Chief Inspector has wide discretion in deciding whether to impose conditions of Registration on nursing homes.
The Deputy will be aware that the Nursing Homes Expert was established, on foot of a NPHET recommendation, to examine the complex issues surrounding the management of COVID-19 among this particularly vulnerable cohort. This Expert Panel report has added further to our knowledge and learning. This report clearly outlines the key protective measures that we must ensure are in place across our nursing homes. These actions are based on learning from our own and the international experience of COVID-19 to date. The report also recommends additional analysis and examination of the relevant public health and other data sets in order that further causal and protective factors for COVID-19 clusters are identified. HIQA and the Health Protection Surveillance Centre (HPSC) recently jointly published an “Analysis of factors associated with outbreaks of SARS-CoV-2 in nursing homes in Ireland”, delivering on recommendation 6.7 of the Expert Panel report, to further the learning from the pandemic. Further data analysis work and learning will also continue, in line with other recommendations of the Expert Panel, but unfortunately have been impacted by the recent cyberattack on the health system.
Work to progress the recommendations of the Expert Panel report, particularly those recommendations requiring a priority focus in the response to COVID-19, is ongoing across all of the health agencies and stakeholders. Continued learning and understanding of progression of the disease in Ireland is an integral part of those recommendations.
Many of the short- and medium-term recommendations have already been implemented. The significant examination undertaken by the Expert Panel provides important learning and a framework for enhancing older persons services both in the short and long-term and this work is progressing.
A number of supports have been made available to nursing homes throughout the pandemic, including:
- the provision of Personal Protective Equipment (PPE);
- COVID-19 Response Teams;
- the HSE temporary accommodation scheme;
- serial testing for nursing homes
- HSE training and development resources, which were opened up to private and voluntary providers
- IPC support and advice; and
- the suite of guidance developed to support the sector
At a broader level, there has been significant and ongoing consideration of this impact since the start of the pandemic, with various examinations and development of reports with a focus on COVID-19, its impact on nursing homes and the pandemic learnings that can inform future policy, regulation and the model of care for older persons. There has been a very clear national commitment to continue to learn from the pandemic as the national and international understanding of the virus evolves, and where necessary to ensure that the public health-led approach evolves, as evidence and learning materialises. Findings of these reports confirm that the very infectious nature of COVID-19 makes it difficult to prevent and control in residential care settings. The reports produced nationally identify findings consistent with international evidence, which have highlighted that the probability of COVID-19 introduction into nursing home depends on the levels of the disease circulating in the community, with a higher risk associated with higher incidence rates in the community.
While significant progress has being made in relation to the roll-out of the vaccination programme and the current situation in nursing homes is broadly stable, the prevalence of the more transmissible Delta variant is rapidly increasing in Ireland and this poses a significant risk, in particular to those who are not yet fully protected though vaccination. It must be recognised that the pandemic has not concluded and at this time a priority focus of Government remains on the ongoing management of the COVID-19 response, to ensure that the positive gains now been experienced are preserved, and that those most vulnerable to the virus continue to be safeguarded, having regard to the residual risk.
While we are still dealing with a level of risk in nursing homes, we are continuing to look at options which may be available to the State in relation to listening to the voices of those who have lost a loved one.