Coronavirus underscores ‘need for reform’ of regulatory system

The Covid-19 pandemic “shone a spotlight” on a need to reform the regulatory system for social care, including nursing homes, the State’s health watchdog has said.

In an opening statement to be delivered to the Oireachtas health committee on Tuesday morning, the chief executive of the Health Inspection and Quality Authority (Hiqa) will say that the "practices and models underpinning service provision that were previously acceptable are no longer so".

Phelim Quinn will tell the committee that the virus has not itself "signalled the need for regulatory reform; rather it has shone a spotlight on an issue that was already in need of urgent consideration".

Hiqa produced a report on the need for regulatory reform of the social care sector in February of this year. It included suggestions on how areas relating to the pandemic could be strengthened, including infection control, staffing, governance and clinical oversight.

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The committee will hear of “deficiencies in the legislation which regulates social care services” highlighted by Covid, but also that “many weaknesses have persisted over the past number of years, due in large part to the evolving nature of service provision.”

It is calling for reform of legislation and regulations pertaining to health and social care and for unregulated forms of care to be brought under a regulatory umbrella. It is also calling for a “framework that makes a clear distinction between the purchaser and provider of services along with clear governance and accountability arrangements”. Hiqa will tell the committee that it believes there has been a “justified focus on how we care for older citizens. It is imperative that there are equitable protections for people with a disability in need of social care and support.”

In a review published last year, Hiqa found that residents living in congregated settings “experience a poorer quality of life compared to those who live and receive care and support in community settings”. It will warn the committee that current regulations can be “overly restrictive when it comes to the development of innovative new models such as partnerships between other service providers and families to develop individual responses to the care and support of those with complex needs”.

Nursing homes virus free

Kathleen MacLellan, assistant secretary at the Department of Health, will tell the committee that vaccination is having an effect in nursing homes, with the number of open outbreaks in such facilities down to 68 from 178 a little more than a month ago. Dr MacLellan will say that one-third of nursing homes remained Covid-19 free since the start of the pandemic, and many who did experience an outbreak "managed very well". Nonetheless, some 2,009 deaths have been linked to Covid-19 in nursing homes.

She will tell the committee that the department is in “broad agreement” with Hiqa, and the recommendations of an expert panel report on nursing homes published last year, which also called for enhanced regulatory frameworks for older people. She will note the sanction of additional inspectorate staff for Hiqa “to support a sustained increase in the frequency of inspections”.

Meanwhile, she will also say that Minister for Health Stephen Donnelly has approved "interim enhancements" to the current regulatory framework as a wider review of regulation is prepared for next year.

The interim enhancements, she will say, improve enforcement and oversight powers of the chief inspector and increase legal underpinning of infection prevention and control obligations.

The committee will hear from Dr MacLellan that Covid “has highlighted the important need to move to new models of care for older people”, including new housing models, care at home and other forms of care that “support people to continue to live in the community in their own homes for as long as possible, thereby participating to their full potential in economic and social life”.