A public inquiry should be carried out into coronavirus-linked deaths that took place in nursing homes, a confidential draft report by the Oireachtas Covid-19 committee has found.

According to a draft of the committee’s final report, seen by The Irish Times: “The State … became overly focused on preparing acute hospitals for the oncoming pandemic in February and March and failed to recognise the level of risk posed to those in nursing homes.”

The report states that the inquiry should examine the "large-scale discharge of patients from acute hospitals", as well as "decision-making around those discharges" by hospitals, the HSE, the Department of Health, the Government and the National Health Public Emergency Team.

Hospital Report

A recommendation made in March by the emergency team that visitor bans to nursing homes were “premature” should be examined.

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It also makes wide-ranging recommendations about testing and tracing, the conditions of lower-paid workers in nursing homes and meat plants and the powers of regulatory bodies.

The turnaround time for testing and tracing should not be more than 24 hours, the report finds, adding that “the HSE has a lot of work to do to get it right, particularly regarding contact tracing”.

“The turnaround times are simply too slow and the testing of close contacts of positive cases is not robust,” it finds. Currently, median end-to-end turnaround times for community samples range between two and 3½ days to be completed, the committee heard last week.

‘Systemic weaknesses’

The report also outlines a range of “systemic weaknesses” in how public services are provided that it says have been highlighted by Covid-19, and calls on the relevant Oireachtas joint committees to examine them.

These include an over-reliance on institutional care for vulnerable people, and “the ongoing decisions being made by the HSE to place residents in nursing homes that have compliance issues, especially with infection control”.

There has been a failure to invest in acute and step-down hospital bed capacity, which led to the State having to transfer more than 10,000 people into long-term residential settings to prepare the acute hospital system for the arrival of Covid-19 patients, the report finds.

It also says there is a “lack of coherent policy on the care of older people”, with tax incentives creating a situation whereby ownership of institutions has “flipped” from the public to the private sector in the past 30 years.

Workers in nursing homes and meat plants felt “compelled to attend for duty even though they were potential carriers of the virus due to the absence of income support if they reported sick,” the draft finds. It recommends that there should be a provision for a statutory sick pay scheme for low-paid workers, and that Covid-19 be made a notifiable disease under health-and-safety regulations.

An “urgent review” is needed of the regulatory framework of regulators Hiqa and the Health and Safety Authority by the end of the year, and the report finds that “the workload of both regulators was such that [they] did not have the capacity to fully investigate compliance”.

Nightingale wards

Meanwhile, the report recommends the State should not support facilities where residents don’t have adequate self-isolation facilities. It criticises “Nightingale-type wards” where residents live, eat and spend most of their time, with communal wash facilities.

It recommends that Dáil committees should review the communication strategies of their departments to ensure they are without “ambiguity or room for confusion”, which “unfortunately has not always been the case”. The committees should also review all Covid-19 legislation in their sector, the report finds.

Legislation related to Covid-19 should have a “sunset clause”, and when being renewed should require the express approval of the Oireachtas.

The draft report is set to be discussed by the committee next week. A technical extension may be needed in order to finalise the report, with the committee set to be disbanded next week.