'Significant changes' needed for how Ireland cares for vulnerable people, HSE says

The head of the HSE says that the organisation is "open to learnings" in relation to the transfer of older people from hospitals to nursing homes.
'Significant changes' needed for how Ireland cares for vulnerable people, HSE says
HSE Director-General Paul Reid arriving at Leinster House for the meeting of the Covid-19 committee today. Photo: Gareth Chaney/Collins

The head of the HSE says that the organisation is "open to learnings" in relation to the transfer of older people from hospitals to nursing homes.

Paul Reid was speaking today at the Oireachtas Committee on Covid-19 but stopped short of saying that he would approach things differently.

In his opening statement to the Oireachtas Committee, Mr Reid said governance in the private nursing home sector needs to be significantly developed.

Under questioning from Fianna Fáil's Mary Butler about the process which saw hundreds of elderly patients transferred from acute hospitals to nursing homes, Mr Reid said that the decisions made in March were done so on the basis that older people were more vulnerable to the virus.

Mr Reid said there was "limited information" on the impact of the disease in care settings until the end of March. By this time, nursing home infection was at its peak.

Mr Reid said that older people at that time had not been presenting with many symptoms.

"The evidence of the transmission of the disease, particularly as we experienced it here in Ireland where people who were elderly and frail didn't experience the symptoms that was projected as part of the normal case definition.

"So they weren't symptomatic and the transmission occurred through asymptomatic persons as well and residents and others."

However, Ms Butler pushed the witnesses from the HSE and Department of Health on whether transfers from hospitals to nursing homes was the right approach. She said that she feared in a second wave of the illness, the same approach could be used.

"We (the committee) accept that everything was done in good faith, But if you're going to take the same approach again, and 1,075 people lost their lives in nursing and residential care settings, I don't want to be part of that going forward. If we're not going to learn from our mistakes, and we will test people at the right time."

Ms Butler said that there was a 70% increase in patients sent to nursing homes in March 2020 compared to the year before, but there is no record of how many people were tested.

Mr Reid said that the HSE was "wide open to learning" and said that changes had been made during the height of the outbreak, including to the case definition and criteria for testing.

"As we've gone through the process, our approach has changed. As we look forward to the future, I have no doubt our approach will change. And that's part of the learning, it's part of learning of this virus."

Sinn Féin's Louise O'Reilly, meanwhile, said that she did not "find it credible" that the transfer of patients was done on a case-by-case basis and not as policy as claimed by the HSE's Chief Clinical Officer, Dr Colm Henry.

"There was no memo issued to instruct the transfer of patients to clear space in the hospital, that was just done on a case by case by case basis by individual clinicians? I have to tell you, I don't find that a very credible statement.

"It strikes me that you had a plan to use the capacity in the nursing home sector but you had no plan to protect the nursing home residents and I hold no candle for the private nursing home sector but you have a duty of care to the patients not to the private nursing home sector, but to the patient's in data into the residents in those nursing homes, all of whom will be entitled to the full protection of PPE, the full protection of the state and I don't think that it is enough for people to say that there could have been a hands-off approach.

"It's clear that there was no plan to protect nursing home residents."

David Walsh, national director of community operations at the HSE said that there was additional transitional care funding made available in March to allow people who were inappropriately in hospitals be treated in nursing homes.

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