Dealgan House is a County Louth nursing home which suffered one of the worst Covid-19 outbreaks of the pandemic. A total of 22 residents sadly died following a severe outbreak during the first wave of the pandemic. Dealgan House was so badly affected that the Health Service Executive had to call in staff from the Royal College of Surgeons in Ireland hospital group to run the nursing home for several weeks.

It was reported by the Health Information and Quality Authority found that there were inadequate communication systems and poor oversight of staff training needs and infection control practices. Additionally, the report identified that procedures in place during the outbreak had not ensured that family members of Dealgan House were kept updated and informed of their loved one’s condition or provided the opportunity to be with their loved one during the end of their lives.

Ballynoe nursing home, situated in Upper Glanmire, confirmed the death of 24 residents, in their 51-bed facility, during the Covid-19 Pandemic. A whistle-blower wrote to the HSE and HQIA on 2nd February 2021 stating, ‘I am begging the HSE to go into the home and try save the residents and nurse them better.’ The email detailed several ongoing breaches of infection prevention and control protocols at Ballynoe Nursing Home amid the third wave of the pandemic.

Despite HSE plans to visit Ballynoe during its outbreak in late January, as well as their obligation to be ‘responsible for investigating outbreaks of Covid-19 and providing overall leadership and oversight of outbreak management’, this never happened. The HSE claimed that their response to the Ballynoe outbreak came at a time when they were dealing with many other outbreaks. However, an infectious diseases consultant states that the rate of infection of staff members spoke for itself and required urgent action and prioritisation.

Tara Winthrop Private Clinic situated close to the village of Swords, Co Dublin, confirmed 18 Covid-related deaths of residents. In addition to the confirmed Covid-related deaths, a further 5 ‘suspected Covid-19 deaths’ were recorded. The Health Information and Quality Authority (HIQA) has inspected the Tara Winthrop Private Clinic six times since 2014.

On the 19th of August 2020, the HIQA had two findings of non-compliance and five ‘moderate’ non-compliance with regulations. Furthermore, the clinic struggled with access to the appropriate quantities of personal protective equipment and was required to seek ‘significant levels’ of assistance from the HSE to meet the demand. The clinic admitted, “At times during the outbreak the provider did not have a system, arrangements or the resources in place to maintain the required level of contact with the relatives of residents living in the centre – understandably this led to anxiety among families and relatives.”

However, care home Covid-19 related deaths were closely compared to that of hospital setting, with 62.7% of deaths resulting from Covid-19 in Ireland occurring in care homes, 22.94% were claimed by the hospital sector. Irish hospitals experienced a surge in Covid-19 cases, which resulted in 100,930 incident reports in the first year of the Covid-19 Pandemic, including wrong medication, dosage, failures in care and delayed diagnosis. HIQA’s Director of Regulation Mary Dunnion said historic problems, such as overcrowding, long waiting lists and limited bed capacity, were further exposed during the Covid-19 pandemic.

It is clear that the scope of the regulatory powers afforded to HIQA by the Health Act 2007 is an inadequate and overarching set of regulations which set out governance and management requirements for service providers (public and private) is required. Such reforms could be easily implemented with reference to the approach to the regulation of nursing homes in other jurisdictions. For example, in England, the primary legislation provides fundamental standards for all activities regulated by the regulator (CQC). In addition, the Northern Ireland regulator RQIA has much wider regulatory powers than the HQIA including the power to make an application to the Court for closure of the relevant home.

The current model of regulation of nursing homes in Ireland is not fit for purpose and has resulted in significant neglect and hardship for residents of nursing homes and their families generally. This has been particularly apparent during the Covid-19 pandemic and is borne out by the statistics more particularly outlined above. The current regulatory framework offers no legal certainty and has led to a thoroughly inconsistent level of care for patients throughout Ireland. The state has failed in its duty to vindicate and defend the personal rights of residents of care homes guaranteed by Article 40 of the Constitution. In addition, the state has failed to perform its positive obligations to put mechanisms in place to ensure respect for the lives and private and family life of the residents pursuant to articles 2, 8 and 14 of the European Convention on Human Rights.

An Inquiry provides a key opportunity for scrutiny of said wrongdoings, as well as accountability for those at the forefront of decision-making throughout the pandemic. As hoped by many, a Covid-19 Public Inquiry will inevitably aid the learning and improvement of how the Government and certain service providers operate in future.