Regulator told HSE a month ago that nursing homes were not being supported

The State's health service regulator raised concerns with Health Service Executive chief Paul Reid last month, as coronavirus infections started surging again, that private nursing homes were experiencing significant difficulties finding experienced nurses and infection control experts.

Phelim Quinn, chief executive of the Health Information and Quality Authority (Hiqa), told Mr Reid that private nursing home operators were "regrettably" reporting a "worrying picture" of rising infections and they were not receiving good support from the HSE during Covid-19 outbreaks.

Letters between Mr Quinn, a member of the National Public Health Emergency Team (Nphet), and Mr Reid reveal differences of opinion at the highest levels of the health system around the State’s response to protecting care facilities, the setting most vulnerable to the virus, as the number of daily cases of Covid-19 were doubling during October.

The correspondence was released by Hiqa to The Irish Times under the Freedom of Information Act.

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Mr Quinn told Mr Reid in a letter dated October 6th that the health watchdog had found some areas within the HSE’s network of community health organisations (CHOs) “are more challenged to respond than others, with some citing a lack of available resources”.

He said that both nursing homes operators and Nursing Homes Ireland, the representative body for private homes, have “communicated that their members are experiencing significant challenges in securing infection prevention and control expertise and sourcing experienced nurses to staff their nursing homes”.

Mr Quinn asked the HSE chief for “assurance of an ongoing commitment to, and co-ordination of, the multi-agency response and the availability of the HSE, as the statutory provider of care, to provide support and assistance to the private and voluntary sector in the management of any worsening circumstances as it relates to this notifiable infection”.

He said that the “multi-agency approach” in the first wave of the pandemic in March and April helped put supports in place to minimise the risk to “these extremely vulnerable residents” and called for a co-ordinated “national response” to the “emerging circumstances within the sector”.

“I believe that now more than ever, there is a need for strong lines of communication and escalation pathways between ourselves and the HSE,” he said. “I believe we need to collectively ensure that the co-ordinated response from the CHO and public health response teams is available to meet the emerging national picture.”

Mr Reid replied 10 days later, telling Mr Quinn he was “disappointed” that “certain private nursing home providers are not reporting good support from the HSE”. He asked the regulator for details of facilities who have “reported experiencing any difficulties in accessing support so that any such incidences can be reviewed and, if necessary, addressed”.

Accountability

The HSE chief pushed some responsibility back on Hiqa and private nursing homes.

“For the avoidance of doubt, the support provided by the HSE does not negate the current governance system in which registered providers and Persons In Charge in private nursing homes have a clear accountability and remit for the care and welfare of residents in their own facilities, with Hiqa providing the regulatory framework which oversees this care,” he wrote.

The HSE remains committed to supporting Hiqa on “any regulatory interventions that may be required”, he told Mr Quinn, and he would “welcome an urgent discussion” on how the overall response to “poorly performing nursing homes may be enhanced combining the regulatory and enforcement powers of Hiqa with the operational and clinical expertise in the HSE”.

He said that private and voluntary nursing homes have been provided with “significant financial resources, guidance and training to address the basic safe care requirements during the Covid-19 pandemic” and that the HSE was committed to helping homes with further outbreaks.

“The HSE’s partnership with Hiqa is critical to this and I welcome your own commitment to continue to support our efforts in the interest of residents in long-term care,” he said.

Nursing homes have borne the brunt of the coronavirus pandemic. In the early stages of the pandemic, private nursing homes criticised the State’s slow and inadequate response in providing help on finding replacements for sick staff, the speed and availability of testing and the supply of personal protective equipment.

Almost 40 per cent of deaths related to Covid-19 during October were nursing home residents. There were 103 deaths related to the disease last month, of which 39 were nursing home residents.

The number of staff testing positive for Covid-19 in the HSE’s serial testing programme, aimed at preventing the spread to residents, rose in October with the number of open outbreaks in care facilities more than doubling, from 26 at the end of September to 56 at the start of November.