Hiqa moves to act on nursing homes – but could the watchdog have barked sooner to help prevent more deaths?
:: 60pc of our Covid deaths in nursing homes
LAST week, as the death toll in nursing homes crept towards the 800 mark, the Health Information and Quality Authority (Hiqa) went to check up on the settings yet to have an outbreak.
By doing this, the agency, which monitors the safety and quality of both the healthcare and social care systems in Ireland, said it wants to “support nursing homes to prepare for an outbreak and put in place appropriate contingency plans to deal with same”.
For some, the move to carry out risk assessments, more than a month after the regulator was informed of its first case, is more than a little belated.
“The support in terms of preparedness would have ideally occurred much earlier,” said Tadgh Daly, CEO of Nursing Homes Ireland (NHI).
“The fact that it’s a supportive role is important. We would also welcome the fact that because of their position on the National Public Health Emergency Team (Nphet) they can escalate matters.”
Mr Daly had been critical of Hiqa last month when it issued nursing homes with a 21-page questionnaire to fill out in order to assess preparedness levels. At such a late stage in the pandemic, he said he was surprised by the move.
The self-assessment checklist for owners and managers in the sector was the precursor to on-the-ground inspections which started last week.
In a statement issued to the Irish Independent, Hiqa said it has completed 93 assessments so far. Questions about levels of compliance among those 93 went unanswered.
“At this stage it is not yet possible to determine when the process of assessment will be finalised,” read the statement. “This depends on the number of centres that report suspected Covid-19 outbreaks, or advise that a suspected outbreak was not in fact Covid-19.”
For nursing home operators who have not yet had a case of Covid-19, but are very much in the midst of a battle to keep the virus at bay, the visits have been welcomed.
“The reception on the ground has been positive,” said Mr Daly. “At first members were apprehensive, because the word ‘inspector’ has its connotations. I would see Hiqa going in at the minute in more of a supportive role.”
Unlike Hiqa, which has several senior members on Nphet, the body of medical experts and health service chiefs which has been overseeing the response to Covid-19, Nursing Homes Ireland hasn’t been granted a seat at the table.
Health Minister Simon Harris said it wouldn’t be appropriate for NHI, the organisation which represents nursing home owners, to be on Nphet.
Separately, chief medical officer Tony Holohan said nursing homes were represented by Hiqa, the expert body for the provision of services. For the hundreds of nursing homes across Ireland, and the thousands of residents they care for, Hiqa has been their voice during discussions that have had far-reaching consequences.
One of the earliest causes for concern was whether nursing homes would allow visitors to continue passing through the doors.
Hiqa was represented by Sean Egan, its head of healthcare regulation, at a Nphet meeting on March 10, when the restrictions on visitors to nursing homes was discussed. It was agreed the current practice of restricting visitors to nursing homes was not required and this would be kept under review.
Yet four days before, on March 6, the same day Nursing Homes Ireland announced visitor restrictions, Hiqa also announced it was temporarily ceasing routine inspections of nursing homes.
That decision by nursing homes to close their doors to visitors on March 6 was criticised at the time by Dr Holohan, the most senior health official leading the State’s emergency response to the disease.
On RTÉ radio yesterday morning, Dr Holohan stressed that “visitors did not bring the virus into nursing homes”, in response to questions on whether they should have acted sooner to protect longterm residential care settings.
“There will be visitors who visited nursing homes who may feel responsible for having brought this infection in, and that isn’t true,” he said.
When asked whether the virus was brought in to nursing homes through staff, Holohan said the virus doesn’t move, but people do move.
“People who work in nursing homes will have picked up the infection, and that’s the mechanism through which to get into nursing homes. But it didn’t get in through visitors, it’s important for people who will feel themselves as being in some way implicitly to blame for having visited a loved one at the wrong time, it’s not their fault.”
The comments have been met with intrigue by Mr Daly, who has been vocal about his early calls to restrict visitors.
“I don’t know how Dr Holohan can be so definitive on that,” he said. “I would be asking to see the epidemiology study on that.”
This week, it emerged a whistleblower who works at St Mary’s in the Phoenix Park in Dublin, where 24 residents have died from Covid-19, made a protected disclosure about the handling of the outbreak at the facility.
Among the many serious allegations contained in a 35-page dossier she submitted to Mr Harris and the CEO of the HSE, Paul Reid, were claims about ‘loose restrictions’ regarding visitors in early March.
In an interview with the Irish Independent, she said she made persistent calls for visitor restrictions at that time, and that a decision to permit “non-essential” visits from March 10 to 17 was “horrific”.
“I was working on St Patrick’s Day and to be honest I was tearing my hair out,” she said.
Nphet did not recommend a full restriction on visitors before then, a decision that has been the subject of much criticism.
The staff member sent an email to management expressing her disappointment.
“I said I just felt more could and should have been done to protect our most vulnerable and close our doors,” she said.
“I thought more could have been done to reassure residents families and staff that all measures were being taken to prevent the spread of the virus.”
Last night, Hiqa confirmed it will be carrying out an inspection of Dealgan House, Dundalk, in the near future. To date, 23 residents have died there since April 1, many due to Covid-19.
There are many other cases like Dealgan House and St Mary’s yet to come to light.
When the events in nursing homes are reviewed, some of the important aspects will be the statutory oversight of homes by Hiqa.
To date, more than 60pc of deaths have been in nursing homes.
Under Hiqa standards, nursing homes must have infection control programmes to deal with outbreaks.
Liam Moloney, a solicitor with knowledge of infection outbreaks in prisons and the Hiqa guidelines on infection control, said there are questions to ask of the regulator’s role in managing the outbreak.
“Hiqa has a role here too,” he said.
“If you look at the national standards, the blueprint is there, the national standards for infection control, so what happened here? Why are there so many deaths?
“We knew about this virus in December. Why weren’t Hiqa making contact with nursing homes in January, making sure the guidelines were being adhered to?
“The management of an outbreak is to prioritise the previous offenders, from previous inspections, who may not complied with the relevant recommendations and to do a sweep of all the nursing homes.
“This 21-page document in April, why wasn’t that done in January?
“All of these questions need to be answered.”
I was working on St Patrick’s Day and to be honest I was tearing my hair out