HIQA carrying review into nursing homes operated by Emeis Ireland group
The Health Information and Regulatory Authority has said it is taking escalated regulatory action in relation to two nursing homes identified in an RTE Investigates programme broadcast last night. Deputy Editor Aoife Hegarty discusses the programme and HIQA's response and next steps.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Irish Times
3 hours ago
- Irish Times
I wrote the Leas Cross report. Two decades on, has anything changed in Irish nursing homes?
Almost the worst aspect of the heartbreaking and horrifying scenes from the nursing home RTÉ Investigates programme was the predictability that these should still occur 20 years after the Leas Cross scandal. The Leas Cross report , which I authored, followed a similar exposé on shocking conditions and work practices in the private Leas Cross Nursing Home in Swords. It led to a range of recommendations and the institution of the Health Information and Quality Authority (Hiqa) . Last week's documentary featured scenes of older people allegedly being manhandled, 'forced' down into chairs or left in incontinence pads for so long their clothes were soaked. The persistence of gross institutional abuse of vulnerable older people signals the lack of serious intent and will in the Department of Health and successive governments to address well-signposted problems and proposed solutions to a deeply flawed nursing home system. READ MORE Not only are some of the recommendations from the Leas Cross report as yet unfulfilled, but none of those of significance from the ministerial panel on Irish nursing homes during the Covid-19 pandemic have been met, and others have been watered down. This is despite Irish nursing home residents experiencing very high death rates in comparison with the rest of the developed world and a torrid experience paralleling that of Amnesty UK's report on nursing homes during the pandemic, As If Expendable . At the heart of the problem is the shift from a largely public nursing home system to a private one without debate, foresight or learning from international experience and research. This occurred in a context of multiple failures by the professions, advocacy and the health system to develop a clear blueprint for the development of a high-quality framework for our future care in nursing homes. Put simply, the health service has no control of care standards in the private sector, and in particular what is known as clinical governance, a clear framework for leadership, responsibility and accountability, both internally and externally, in a complex care environment with vulnerable older people. Added to this is a profit-driven business with large chains, at least one of which, Emeis Ireland, has a deeply tarnished reputation outside this country – as detailed in Victor Castanet's book Les Fossoyeurs: Révélations sur le système qui maltraite nos aînés (The Gravediggers: Revelations about the system that mistreats our elders). In some, profit trumps care and, as we saw with the documentary, cost-cutting erodes care. In addition, this is associated with the building of huge impersonal nursing homes distant from the communities where residents formerly lived. Despite Sláintecare pledging to reverse the ratio of private to public nursing home beds, the reverse has happened with an increase in the proportion of private nursing home beds. [ What is Emeis and where are its Irish care homes located? Opens in new window ] The framework is so rickety and uninformed that there is a misplaced belief in regulation and safeguarding. Standards in hotels, restaurants and hospitals are not high because of regulation or safeguarding, but rather because we, the public and professions, have set high expectations of what we should receive. This has long been accepted in healthcare. The author of the first major medical ethics scandal in the US, where African-Americans were left untreated with syphilis, wrote that regulation, while necessary, would never succeed on its own: what was required was a system that upheld virtuous thought and virtuous action. As was obvious from the RTÉ documentary, and long clear to informed healthcare professionals, Hiqa cannot assure the public of appropriate and dignified care standards in Irish nursing homes, nor respond effectively and in a timely manner to grave concerns reported to it. Instead, we need a radical reset of prioritising informed support to residents in nursing homes and those working in them. We can do this while recognising the many who strive to provide good care – they are not tarnished by critique of lack of policy or the inherent problems of an untrammelled private sector. If anything, all suffer if we do not address the glaring problems of the system. There needs also to be soul-searching among the professions about supporting care in this sector. It would be helpful for the Nursing and Midwifery Board of Ireland to engage proactively on advising how nurses should engage with the challenges of providing high-quality care in a profit-driven nursing home system. The public also need to start pushing their politicians to do better. As things stand – and hard as it is to accept – we have no assurance that the scenes played out in the RTÉ documentary are not occurring elsewhere in the Irish nursing home system. The Ombudsman has already pointed to the lack of dignity and choice in Irish nursing home systems. [ Review of all nursing homes operated by Emeis Ireland requested by Department of Health Opens in new window ] It is not just a question of 'it might be my mother' but actually 'it might be me': men have a one in four, and women a one in three, chance of spending time in a nursing home before we die. We need to clearly signal that we expect a setting where choice will be respected and that we can continue to flourish. We must demand a lower tolerance for uninformed passivity from the Department of Health, HSE and other State bodies, and inclusion of stronger advocacy and gerontological voices (notably absent from the ministerial panel oversight implementation team) in responding to this lingering crisis. Politicians are adept at detecting the priorities of their constituents. If we do not push for a better present and future for those we care for and our future selves, nor will they. Prof Des O'Neill is a consultant geriatrician and author of the Leas Cross report 2005-6
Irish Examiner
a day ago
- Irish Examiner
Hip surgery becoming necessary for many children 'due to late diagnosis' amid lack of screening
Questions are being raised as to why 'worrying' gaps in care for children with hip dysplasia — first identified in 2017 and again in a Hiqa report last year — have not been addressed. Healthcare workers were raising alarms about diagnosis, including through a HSE steering group in 2017, even before the latest crisis around surgeries under Children's Health Ireland (CHI) hospitals. By January 2023, concern was so high two medical bodies made a submission to the National Screening Advisory Committee (NSAC). The National Child Health Public Health Programme and the National Clinical Programme for Paediatrics and Neonatology called for ultrasound screening for the condition for all babies instead of only those at high risk. Hiqa was then asked by the NSAC to compare the benefits of selective and universal screening. The NSAC reports directly to the health minister. Hiqa's report team included people from the HSE and Department of Health. The report advised against expanding screening, saying there is 'significant uncertainty' over benefits. However, it found existing systems are not a formal screening programme and not in line with HSE steering group recommendations. It said: Current practice is therefore not supported by the governance, end-to-end care, quality assurance, and monitoring of outcomes that would be associated with such a programme. It is not known how many babies are born annually with hip dysplasia, it said, citing Irish studies showing a range of 'between 400 and 1,800 babies'. Funding was provided by 2017 for ultrasound programmes in maternity hospitals. However, it is not mandatory to report patient numbers, diagnosis, or treatment. One consultant familiar with hip dysplasia care warned: 'So, essentially the steering group was there as spectators, helplessly trying to get information but not actually having the power to gather it and not having the power to act on it.' The urgency was highlighted by the CHI hip surgery audit. The consultant said: In the recent CHI report, if you subtract the unnecessary operations from the overall number, you are left with a lot of necessary operations. In many cases it is likely that they were necessary because of late diagnosis. This is because 'problems arise when the diagnosis is made late. The sooner you spot it, you can treat it in a harness or a brace. And the children respond very well and have excellent results'. However, without a national register, the doctor said 'we have no idea what the national rate of late diagnosis is. I would guess there are probably 80 to 100 babies per year who are presenting with late diagnosis'. Sinn Féin health spokesman David Cullinane questioned long delays in implementing the recommendations or a national audit, saying 'astonishingly the working group has now been disbanded'. 'The recent scandal into unnecessary hip procedures on children demonstrates the importance of the recommendations of the working group,' he said. 'It is worrying that these recommendations were not implemented and this has caused understandable concern for those involved in this valuable work.' The HSE said the steering group was disbanded this year. Its role was to identify ways to find babies at risk. 'These pathways are now in place nationally,' a spokesman said. Responsibility for this is now under the 'relevant clinical and operational governance lines' under each regional executive officer in the new HSE health regions. The Department of Health pointed to communication from the NSAC last month to the two bodies which raised concerns saying the best approach 'would likely be the systematic application of the current selective screening programme'. A spokeswoman said NSAC wrote to the health minister in March 2024 recommending against expanding screening. 'The NSAC Chair noted that the condition would be kept under review as new evidence emerges. This will be considered later this year,' she said. Hiqa confirmed its advice was submitted to NSAC.
Irish Examiner
a day ago
- Irish Examiner
Screening to help babies avoid hip dysplasia surgery still not in place, eight years on
A national screening programme to help babies with hip dysplasia avoid surgery is still not in place eight years after it was recommended. The steering group that made the recommendations was disbanded by the HSE this year. However, none of its recommendations have been implemented. Up to 100 children a year undergo invasive hip surgery because of a late diagnosis, it is estimated. In 2017, the steering group recommended the introduction of a national screening programme to avoid any unnecessary surgeries. Last year, the watchdog, Hiqa, raised concerns that the recommendation had still not been acted on. The watchdog said: 'Current practice is, therefore, not supported by the governance, end-to-end care, quality assurance, and monitoring of outcomes that would be associated with such a programme.' They found evidence that even in the limited approach taken to screening, 'there may be variation in the implementation' between hospitals. One consultant said that if problems with hip dysplasia are detected early enough there might not be any need for surgery. The consultant said: 'Problems arise when the diagnosis is made late. The sooner you spot it, you can treat it in a harness or a brace. And the children respond very well and have excellent results.' However, without a national register, the consultant said: We have no idea what the national rate of late diagnosis is. I would guess there are probably 80 to 100 babies per year who are presenting with late diagnosis. The consultant, who is familiar with care for hip dysplasia, said: 'The whole point about DDH [hip dysplasia] is if you treat it in time, it can nearly all be done non-operatively.' In recent weeks, there has been public outrage over the high number of surgeries and unnecessary surgeries in CHI at Temple St and the National Orthopaedic Hospital, Cappagh. The consultant said: 'In the recent CHI report, if you subtract the unnecessary operations from the overall number, you are left with a lot of necessary operations. In many cases, it is likely that they were necessary because of late diagnosis.' There is now concern in health circles at what the CHI crisis could mean for efforts to address the gaps. 'The whole thing is in chaos now. It's probably seen as toxic. There is no sense of urgency, no sense of determination to get this done,' the consultant warned. Sinn Féin health spokesman David Cullinane said that not only were recommendations not implemented, but also 'no national database or audit was ever put in place'. The recent scandal in to unnecessary hip procedures on children demonstrates the importance of the recommendations of the working group. 'It is worrying that these recommendations were not implemented and this has caused understandable concern for those involved in this valuable work.' The HSE said health regions are now responsible for screening. The Department of Health pointed to communication from the NSAC last month to doctor's groups who raised concerns saying the best approach 'would likely be the systematic application of the current selective screening programme'.
