Oireachtas Joint Committee on Health - February 2021 Opening Statement

Opening Statement
    Oireachtas Joint Committee on
                Health

             February 2021

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Chair and Members of the Joint Oireachtas Health Committee. Thank you
very much for the opportunity to meet with you here today. Accompanying
me are Ms Deirdre Shanagher, NHI Strategic Clinical Nurse Expert with
Regulatory Compliance and Professor Dermot Power, NHI Gerontology
Expert.

We are here representing over 400 nursing homes across the country which
are integral for health and social care in Irish society. The past 11 months
have represented a most arduous and upsetting time for the people in
our nursing homes.

The recent January 2021 data published by NPHET is a stark reminder of the
indiscriminate nature of this deadly virus, with more cases of Covid-19
reported in January 2021 than the total number in the whole of 2020.

Nursing homes are home to people with the highest levels of frailty and with
multiple underlying conditions. Worry and anxiety have been rife for the past
year as staff and residents have lived with a virus that threatens the lives of
the people in our nursing homes.

Greater engagement and collaboration between the nursing home sector and
our public health services has undoubtedly enhanced the supports available
to nursing home residents and staff in the face of a global pandemic that has
presented an unprecedented challenge for our health and social
care services. This collaborative approach with key stakeholders, the HSE
and Department of Health, has included the provision of PPE, serial testing of
staff and timely turnaround of results, provision
of regular specialist HPSC advices and guidance, the Temporary Assistance
Payment Scheme (TAPS) and staffing when available.

It should be noted in response to rapidly increasing numbers of cases in the
community over Christmas we engaged with public health proposing an
increase in serial testing of staff in nursing homes from fortnightly to weekly
during the month of January. This critical measure was undertaken to
support early detection of the virus. The requirement to protect our frontline
health workers also extends to nursing homes and availability of FFP2 masks
is increasing, with public health guidance also updating regarding this
protective measure. Testing and PPE remain critical to protect residents and
staff and enhance the care provided.

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The collaborative approach that was implemented following the onset of
Covid-19, albeit delayed, remains in place. However, the entire health service
is under immense strain, with 6,000+ staff absent due to the virus and over
1,800 being unable to work within our nursing homes. Staffing is the
predominant emergency that presents today across our health services.
Within homes with outbreaks, available staff are going to extraordinary
lengths at huge personal sacrifice to ensure continuity of care.

It should be noted Chairman that the majority of nursing homes are
thankfully not experiencing an outbreak this time. Those that have outbreaks
are severely constrained by the unprecedented circumstances, but thanks to
the tremendous commitment by their teams, they are working through
significant staffing challenges. The situation remains precarious and those
impacted by the virus are under extreme pressure.

Following inordinate and extended delays, we are pleased to inform of
significant progress in reducing the processing times of atypical working
visas for non-EEA nurses. We are continuing our engagement with the
Department of Justice in this regard and will monitor turnaround times
closely to ensure that targets are being met and essential frontline staff are
recruited in a timely manner.

The warnings from public health experts have been consistent and repeated:
heightened prevalence of Covid-19 in our communities presents an
inevitable consequence for our health services and our nursing homes. In
early December, the European Centre for Disease Control warned the then
epidemiological situation and anticipated festive gatherings would pose a
“very high” risk for older people and those in long-term healthcare facilities.
That same organisation warned just two weeks ago the new strains escalates
transmissibility and brings with it, higher death rates.

It is a great tragedy that Covid-19 has manifested again within our acute
hospitals, nursing homes and all residential care settings, with tragic
consequences for many. Covid-19 is not particular to any class or type of
setting. The new strains are highly transmissible across our health settings
and within broader society.

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A new beginning is slowly emerging. The rollout of the vaccination is bringing
huge relief and hope within nursing homes. The biggest reaction amongst
residents, staff and families is thankfully euphoria and it is important to
acknowledge the contribution of the vaccination teams and all stakeholders
in the roll out. It has been a success across the country, with the feedback
very positive and extremely high levels of uptake being reported amongst
residents and staff.

However, we do feel a critical window of opportunity was missed. With
nursing home residents the most susceptible to the virus, just 10% of
the initial 77,000 vaccinations administered by mid-January were
within nursing homes. It is appropriate to remind that the National
Immunisation Advisory Committee agreed nursing home residents and
staff would be priority 1. The first vaccines arrived in Ireland on
26th December yet the first was only administered in a private or voluntary
nursing home on 7th January 2021. Every day is vital for our nursing home
residents and staff.

We are grateful that our representations for vaccine administration to be
expedited, entailing utilising every available day, were heeded
and implemented. We believe our suggestion that a nominated visitor for a
resident should also be vaccinated remains a good and practical one in
addressing some of the challenges associated with visitor restrictions.

A system also needs to be outlined with urgency for those residents and staff
who missed the vaccine the first time due to having Covid and for new
admissions to nursing homes, from acute settings and the community. We
remain engaged with a view to securing commitment from the HSE and
public health to immediately bring into effect a policy to address this
important issue.

Vaccination is bringing us towards a new dawn for the relatives and friends of
nursing home residents. But there is a way to go and to protect our most
vulnerable; the public health advices entail ongoing temporary
but extended visitor restrictions, bringing tremendous pain and sorrow.
Nursing homes have strived to ensure meaningful engagement has been
supported through the nursing home and will continue to be guided by
the public health advices. Based on our engagement with public health, the

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strong indication is enhanced IPC measures will be required for some time;
we cannot let our collective guard down as a society based on vaccination.

Today’s agenda encompasses supports for nursing home residents. I have
spoken previously in the Oireachtas about the Fair Deal and the requirement
to publish the long-awaited Pricing Review which was due for publication in
2017 and reform of funding model to ensure a fit for purpose Nursing Home
Support Scheme. HIQA too needs to work with homes to better understand
the severe challenges of the last year and those that presently present and to
also work with providers and staff in a supportive and empathetic manner.

It is the opinion of Nursing Homes Ireland that an enduring legacy must
emanate from the tragedy of Covid-19. Teams of health and broader care
professionals come together in 500+ communities across the country to
deliver this highly specialised care to people with highest dependency
and multicomplex health and social care needs.

Residential care of our ageing population cannot be allowed drift from your
consciousness – you the legislators responsible for health policy and
resourcing. There are many issues that remain in cul de sacs and we look
forward to engagement in the months ahead on the reform agenda.

The necessity to more tightly integrate nursing home care into our health
services – a core recommendation presented by the Covid-19 Nursing Homes
Expert Panel – must become an immediate priority.

In conclusion, I want to thank staff for their heroism in providing care to our
most vulnerable during a pandemic. Great pride is assumed by people within
our nursing homes in providing person-centred, compassionate care and I
pay tribute to staff, managers and owners for their dedication. We extend
our sympathies to the loved ones of all residents and staff who have lost their
lives because of this awful pandemic. For residents, my wish today, which I
am sure is yours too, is that soon they will get back to a familiar norm of open
visits, hugs and hope.

ENDS

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